Notice of Privacy Practices

Notice of Privacy Practices

  • KC Smile PA

    * You May Refuse to Sign This Acknowledgment
    I have received a copy of this office's Notice of Privacy Practices.
  • SignatureDate
  • For Office Use Only

    We attempted to obtain written acknowledgement of receipt of our Notice of Privacy Practices, but acknowledgement could not be obtained because:
    • Individual refused to sign
    • Communications barriers prohibited obtaining the acknowledgement
    • An emergency situation prevented us from obtaining acknowledgement
    • Other (Please Specify)

Questions about a procedure?


Dental News

dentist overland park

Meet the Doctor

Ross S. Headley, DDS

Using the most advanced materials and techniques, Dr. Ross S. Headley will transform your smile. As Kansas’ only accredited member of the American Academy of Cosmetic Dentistry, Dr. Headley understands how unhealthy or unattractive teeth can negatively impact a patient’s life. He witnesses daily how beautiful healthy teeth change lives. Take a moment and explore the options available for you.

Kansas’ Only Dentist Accredited by the
aacd certified

Patients Love Us

What Patients are Saying Online

We are focused on building a long-lasting relationships with our patients