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I am aware that NSCD will be providing an estimate of insurance coverage prior to initiating any future treatment. I also understand that it is my responsibility to inform NSCD of any changes to my child s medical history and/or status. I also understand that it is my responsibility to inform NSCD of any changes to my child s insurance information. Authorization for Direct Payment I hereby authorize payment of insurance benefits directly to North Scottsdale Children s Dentistry. Name...
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North Scottsdale Children's is a non-profit organization dedicated to providing educational and recreational programs for children in the North Scottsdale area.
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