HHS Notifications and Statements


English
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Español (Spanish)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



(Chinese)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Tiếng Việt (Vietnamese)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



(Korean)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Tagalog (Tagalog – Filipino)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Русский (Russian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



العربية(Arabic)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Kreyòl Ayisyen (French Creole)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Français (French)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Polski (Polish)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Português (Portuguese)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Italiano (Italian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Deutsch (German)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



(Japanese)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



فارسی (Farsi)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



हिंदी (Hindi)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Հայերեն (Armenian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



ગુજરાતી (Gujarati)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Hmoob (Hmong)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



اُردُو (Urdu)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



ខ្មែរ (Cambodian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



ਪੰਜਾਬੀ (Punjabi)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



বাংলা (Bengali)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



אידיש(Yiddish)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



አማርኛ (Amharic)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



ภาษาไทย (Thai)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Oroomiffa (Oromo)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Ilokano (Ilocano)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



ພາສາລາວ (Lao)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Shqip (Albanian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Srpsko-hrvatski (Serbo-Croatian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



укРаїнська (Ukrainian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



नेपाली (Nepali)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Nederlands (Dutch)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



unD (Karen)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Gagana fa'a Sāmoa (Samoan)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Kajin Ṃajōḷ (Marshallese)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Română (Romanian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Foosun Chuuk (Trukese)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Tonga (Tongan)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Bisaya (Bisayan) .
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Ikirundi (Bantu – Kirundi)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Kiswahili (Swahili)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Bahasa Indonesia (Indonesian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Türkçe (Turkish)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



کوردی (Kurdish)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



తెలుగు (Teluga)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Thuɔŋjaŋ (Nilotic – Dinka)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Norsk (Norwegian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Català (Catalan)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



λληνικά (Greek)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Igbo asusu (Ibo)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



èdè Yorùbá (Yoruba)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Lokaiahn Pohnpei (Pohnpeian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Deitsch (Pennsylvania Dutch)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



hoʻokomo ʻōlelo (Hawaiian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Adamawa (Fulfulde)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



tsalagi gawonihisdi (Cherokee)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



I linguahén Chamoru (Chamorro)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



ܣܘܼܪܸܬ݂ (Assyrian)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Burmese written in Burmese characters. (Burmese)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Diné Bizaad (Navajo)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



(Bassa)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html



Chahta (Choctaw)
» Notice of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html

» Statement of Nondiscrimination

[Name of covered entity] Summit Dental - William Samson DDS
[Mailing address] REPLACE: Civil Rights Coordinator Mailing Address
[Telephone number] REPLACE: Civil Rights Coordinator PHONE
[TTY number—if covered entity has one] REPLACE: Civil Rights Coordinator TTYPHONE
[FAX] REPLACE: Civil Rights Coordinator FAX
[Email] REPLACE: Civil Rights Coordinator EMAIL
[Name of civil rights coordinator] REPLACE: Civil Rights Coordinator
[Name and Title of Civil Rights Coordinator] REPLACE: Name And Title Of Civil Rights Coordinator
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf http://www.hhs.gov/ocr/office/file/index.html





William Samson, DDS
Summit Dental

1805 W. Dickerson
Bldg. 2, Suite 2
Bozeman, MT 59715
MAP

Call 406-404-1186
Monday - Friday: 8am to 5pm







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1805 W. Dickerson, Bldg. 2, Suite 2, Bozeman, MT 59715
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