The Dental Center of South Bend
1005 East LaSalle Avenue, South Bend, IN 46617

Privacy Policy

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information (protected health information) used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

Without specific written authorization, we are permitted to use and disclose your health care records for the purposes of treatment, payment and health care operations.

  • Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. Examples of treatment would include crowns, fillings, teeth cleaning services, etc.
  • Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be billing your dental plan for your dental services.
  • Health Care Operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would include a periodic assessment of our documentation protocols, etc.

In addition, your confidential information may be used to remind you of an appointment (by phone or mail) or provide you with information about treatment options or other health-related services including release of information to friends and family members that are directly involved in your care or who assist in taking care of you. We will use and disclose your protected when we are required to do so by federal, state or local law. We may disclose your PROTECTED HEALTH INFORMATION to public health authorities that are authorized by law to collect information, to a health oversight agency for activities authorized by law included but not limited to: response to a court or administrative order, if you are involved in a lawsuit or similar proceeding, response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested. We will release your PROTECTED HEALTH INFORMATION if requested by a law enforcement official for any circumstance required by law. We may release your PROTECTED HEALTH INFORMATION to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs. We may release PROTECTED HEALTH INFORMATION to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor. We may use and disclose your PROTECTED HEALTH INFORMATION when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat. We may disclose your PROTECTED HEALTH INFORMATION if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities. We may disclose your PROTECTED HEALTH INFORMATION to federal officials for intelligence and national security activities authorized by law. We may disclose PROTECTED HEALTH INFORMATION to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations. We may disclose your PROTECTED HEALTH INFORMATION to correctional institutions or law enforcement HIPAA/@Notice of Privacy Practices.doc officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals or the public. We may release your PROTECTED HEALTH INFORMATION for workers’ compensation and similar programs.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have certain rights in regards to your PROTECTED HEALTH INFORMATION, which you can exercise by presenting a written request to our Privacy Officer at the practice address listed below:

  • The right to request restrictions on certain uses and disclosures of PROTECTED HEALTH INFORMATION, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
  • The right to request to receive confidential communications of PROTECTED HEALTH INFORMATION from us by alternative means or at alternative locations.
  • The right to access, inspect and copy your PROTECTED HEALTH INFORMATION.
  • The right to request an amendment to your PROTECTED HEALTH INFORMATION.
  • The right to receive an accounting of disclosures of PROTECTED HEALTH INFORMATION outside of treatment, payment and health care operations.
  • The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your PROTECTED HEALTH INFORMATION and to provide you with notice of our legal duties and privacy practices with respect to PROTECTED HEALTH INFORMATION.

We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all PROTECTED HEALTH INFORMATION that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from this office.

You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.

For more information about our Privacy Practices, please contact:
Dental Care Alliance
6240 Lake Osprey Dr.
Sarasota, FL 34240
Ph #: 941-955-3150

For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (toll-free)

Read What Our Patients Say
Patient Reviews
Very reasonable prices for people without dental insurance, courteous fast service!
Ryan K.
Very pleasant experience
Anonymous
I had an excellent experience.
Jamie T.
Very nice, helped me supa fast
Susan J.
I appreciate the attentiveness and friendliness of the Dental Centers personnel. I feel they are interested in my dental and overall health.
Michael A.
Friendly, professional, and caring.
Mary B.
Very professional & expert care, and only discomfort that I deserved. Great people.
Anonymous
Friendly & excellent service !!
Don H.
For my first time at this practice, everyone was very nice and courteous..I felt like they really care
Treviea W.
Been going to this clinic for almost two years now. I have enjoyed my experiences with this clinic and I am thankful to them.
Jamie T.
Everyone there is great!
Christin A.
I was in pain over the weekend. I called Monday morning and they got me right in on Monday afternoon to take care of my very bad tooth pain. Thank […]
Jason P.
Even an extraction is no problem.
Michael A.
Fast and painless!
Kelly T.
I have always had good service there . Been going there for about 15- 20 years
Ronald P.
Dentist at the dental center are there to help you, not tell you things are wrong just to get more money out of you. They are all very friendly and […]
Rikki T.
I had a great experience at the dental center. They are flexible with appointment times and the staff (front desk, hygienists, and doctors) is very […]
Anonymous
Marge was very good. She is an excellent dental heigist. So very glad I have her caring for my health and teeth. Thank you, Marge great job!
Sue B.
Excellent service provided by hygienist Becky W.
Rebecc D.
Marge always pleasant an professional. I only use her for my cleanings.
Kevin S.
Overall good impression. Got what I was expecting.
Lila K.
Great service and excellend customer service provided by staff.
Ariel E.
No wait time, Very helpful and informative as to the procedure and what to expect. Excellent staff and dentist.
Anonymous
Friendly and caring staff. Always helpful with questions or concerns.
Richell K.
The staff was very courteous and nice. The service I received was very good. My wait time was minimal.
Marvin J.
My procedure took 4 hours, mainly because there was only 1 dentist and he had to handle many patients while I sat in the chair. There was more down […]
Jane B.
Got in on time and everything went well.
Judy J.
excellent and courteous service
Joseph V.
Outstanding caring people, always know me by name also.
Kevin S.
My hygienist was excellent and very professional
Soneka W.
very professional
Anonymous
I find the people in this office to be friendly and professional.
Steven S.
This morning at 8:30 I called for an appointment for what I thought was a cracked tooth. I had never been a patient there before, they got me in with […]
Amy darnell
While I did have a couple of resin fills fall out, I don't believe that was the fault of the technician (my bad). They were replaced right away and […]
Timothy F.
Dr.Madu was very considerate of my level of comfort.
Peggy M.
I love coming here! Fast, great work and painless!
Braedon T.
Love this office. Everyone treats you great
Gayle B.
Quick in job done without any pain
Eric W.
The people are friendly and courteous and the work on my tooth was completed in a timely manner.
Tricia W.
One of the best dentist appt I have been to
Leah N.
As always excellent service from hygenist, Becky.
Rebecc D.
They are very helpful and friendly..
Rena M.
Everyone very courteous and professional as well as friendly!
Lisa R.
Had an emergency on my front tooth! Not only did they get me in right away but also worked quickly to get me a flipper tooth (in a day and a half)! […]
Angelia Y.
very nice service in a timly manner
Larry C.
Very kind and professional people work here. My experience was very good.
Joan W.
Very thorough and professional.
Jacquelin C.
By far the best experience I have ever had while having to get a filling replaced.
Tammy W.
Overall good experience.
Sherry D.
I had a wonderful experience. I arrived early and was informed that the hygienist was out sick and they apologized for it. They offered to reschedule […]
Jacqueline S.
Office Hours
Mon. – 8:00 AM - 5:00 PM
Tue. – 8:00 AM - 5:00 PM
Wed. – 8:00 AM - 5:00 PM
Thu. – 8:00 AM - 5:00 PM
Fri. – 8:00 AM - 2:00 PM
Sat. – Closed
Sun. – Closed
Phone: (574) 367-7000
Fax: (574) 245-7530
Healthcare Financing with
CareCredit
We Accept Most Insurance Plans!
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We accept most insurance plans and will be happy to help you understand the coverage that you have. We will do our best to see that you receive your maximum insurance benefits for all covered services.

No Insurance? No Worries! See our discounts and offers here

For appointments, call us at: (574) 367-7000 or
Request an Appointment
For appointments, call: (574) 367-7000
Office Hours
  • Monday 8:00 AM - 5:00 PM
  • Tuesday 8:00 AM - 5:00 PM
  • Wednesday 8:00 AM - 5:00 PM
  • Thursday 8:00 AM - 5:00 PM
  • Friday 8:00 AM - 2:00 PM
  • Saturday Closed
  • Sunday Closed
Get in touch:
  • Phone: (574) 367-7000
Our Location