Office Hours
Mon/Thurs 7am-7pm
Friday 7am-4pm

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Make A Payment

In order to process payment, information must include the complete name found on the credit card, credit card type, account number, and expiration date. Required fields are highlighted in yellow.

First Name:
Last Name:
Address (Line 1):
Address (Line 2):
State: Zip:
Email Address:

Fort Wayne Dental Account Number:
Payment Amount: $

Credit Card:    Account No:

Expiration Date: /

The CCV# is found on the reverse side of your credit card.
It will be on the right side, right under the magnetic strip.

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Fort Wayne Dental Group will send an email confirmation
within 24 to 48 hours.