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Page 1: · EXCEPTIONAL DENTISTRY HIPAA Acknowledgement of Receipt of Notice of Private Practices Mirtha Amador, DM[) 357 Almerio Ave., Suite 105 Coral Gobles, FL 33134

Page 2: · EXCEPTIONAL DENTISTRY HIPAA Acknowledgement of Receipt of Notice of Private Practices Mirtha Amador, DM[) 357 Almerio Ave., Suite 105 Coral Gobles, FL 33134

Page 3: · EXCEPTIONAL DENTISTRY HIPAA Acknowledgement of Receipt of Notice of Private Practices Mirtha Amador, DM[) 357 Almerio Ave., Suite 105 Coral Gobles, FL 33134

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