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FRIENDS and AMIGOS
DENTAL

SOME COVERAGES ACCEPTED*:

Aetna

Avesis

Blue Cross Blue Shield

Cigna

Delta

Gateway

Geisinger

Health Partners

Keystone First

LEHB

Humana

Principal

United Healthcare

Unum

UPMC FOR YOU

*subject to change. Patient/Responsible Party is responsible for verifying their plan and eligibility

Call 267-270-5057 to Schedule With Our Team Today!!!

We see KIDS and ADULTS!!

We have SCHOOL FORMS to help your child stay in good standing with the Philadelphia School District

Black mother age 29 with her 6 year old daughter at the dental office. Daughter is being

1938 South Columbus Blvd, Philadelphia PA 19148
(In the Columbus Commons North Shopping Plaza. Our office is next to the Wine and Spirits)

Friends and Amigos Dental PLLC Notice of Privacy Practices Effective Date: 05-01-2026

This notice explains how your dental and medical information may be used or shared and your rights regarding that information. Please read carefully.

1. Our Responsibilities

We are required by law to maintain the privacy of your protected health information (PHI) and to provide this notice. We must follow the terms of this notice and notify you of changes.

2. How We May Use or Share Your PHI

Treatment: Coordinate your dental care.
Payment: Bill you or your insurance for services.
Healthcare Operations: Quality reviews, staff training, or administrative tasks.
Appointment Reminders: Calls, texts, or emails.
As Required by Law: Public health, abuse reporting, court orders, or other legal requirements.

3. Uses Requiring Your Written Authorization

Marketing purposes or sale of PHI.
Uses not described above.

You may revoke authorization at any time in writing, which will not affect prior disclosures.

4. Your Rights

You have the right to:

Inspect and copy your records.
Request restrictions on use or disclosure.
Receive communications by alternative methods.
Request amendments to your records.
Request an accounting of disclosures.
Receive a paper copy of this notice at any time.

5. Complaints
If you believe your privacy rights have been violated, you may contact:

Friends and Amigos Dental PLLC Privacy Officer- Our location’s dentist
U.S. Department of Health & Human Services, Office for Civil Rights: www.hhs.gov/ocr/privacy

No retaliation will occur for filing a complaint.

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