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Doctor Referral Form

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Referral Instructions

  • Open and fill out this form:
    Referral Form
  • Once completed, download and save the form to your computer 
  • Upload the form to the upload field to the form on the right and hit submit

If you have any questions, please contact us at mail@prairieoralsurgery.com or call us at 701.478.4404

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Dental/Surgical Assistant

Surgical Assisting Staff
Job Summary

We are continuing to grow and are looking to add to our fabulous team. This is a full time position with benefits. Your daily responsibilities would vary from assisting to seating to circulating. We are seeking a team player who is eager to learn and contribute to this outstanding specialty. Email amy@prairieoralsurgery.com

Privacy Practices

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Prairie Oral Surgery is committed to preserving the privacy and confidentiality of your health information. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. Please review it carefully.


This form, Notice of Privacy Practices, presents the information that federal law requires us to give our patients regarding our privacy practices.

Our Legal Duty

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect May 15, 2015, and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.

You may access or obtain a copy according to the following options: 1) download a full pdf version from our website (available below), 2) contact the office and request a copy be sent to you by main or email, 3) request a copy at the time of your next appointment. Please contact us if there’s additional concerns or questions.

Uses and Disclosures of Protected Health Information

Your PHI may be used or disclosed for the purpose of providing healthcare services to you.

Treatment: We will use or disclose your PHI to provide, coordinate or manage your dental care and any related service.

Payment: We will use or disclose your PHI to obtain payment for the dental care services provided by this Practice. We may use or disclose your PHI to verify eligibility or coverage for benefit determination or so a bill can be sent which includes services provided.

Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Business Associates: We may share your PHI with third party business associates such as answering services, billing services, consultants, etc. We obtain a written agreement between our Practice and the business associate to assure the privacy and protection of your PHI.

Your Authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. If you revoke this authorization, we will no longer use or disclose your PHI; however, we are unable to retrieve previous disclosures made under the prior authorization.

Students: We may share PHI with students working in our Practice to fulfill their educational requirements. If you do not wish a student to observe or participate in your care, please notify your provider.

Family and Close Friends: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.

Persons Involved In Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.

As Required by Law: We may use or disclose your health information when we are required to do so by law. Please see examples as provided in the full Notice of Privacy Practices.

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information if necessary to avert a serious threat to your health or safety or the health or safety of others.

Disaster Relief: We may disclose your PHI to an authorized public or private entity to assist in disaster relief efforts.

National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages or letters).

Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization.

Patient Rights

Access: You have the right to look at or get copies of your protected health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. You may also request access by sending us a letter to the address at the end of this Notice. If you request copies, we may assess a $20.00 charge for staff labor and copying charges, in accordance with North Dakota law. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of your health information for a fee. Our Practice does not transmit unsecure PHI via email.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. You must submit your request in writing to the Privacy Officer.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). If you paid out-of-pocket for a service, you have the right to request that information not be disclosed to a health plan for purposes of payment or health care operations.

Confidential Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request. Our staff will not ask personal questions regarding your request.

Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.

Breach Notification: You have the right to be notified following a breach of unsecured PHI that affects you.

Electronic Notice: If you receive this Notice on our Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form.

Questions & Complaints

We support your right to the privacy of your protected health information. Please, contact us if you want more information about our privacy practices, or if you have questions or concerns. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice.

You also may submit a written complaint to the Secretary of Health and Human Services at: U.S. Department of Health and Human Services, Office of Civil Right, 200 Independence Avenue, SW, Washington DC 20201. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Dept. of Health & Human Services.

Contact Officer

Office Administrator, Prairie Oral Surgery
2585 23rd Ave S, Suite #A
Fargo, ND 58103
Email: Click Here to E-mail Privacy Officer

Patient Instructions

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Many patients are scheduled for procedures performed with a local anesthetic, and, if this is true for you, no additional preparations are necessary before your surgery unless you have been otherwise instructed.

If you are a patient scheduled for a procedure performed with sedation, please read the following instructions:

  • Wear comfortable clothes, preferably a short sleeve shirt.
  • Bring a list of your medications.
  • Complete and bring your Patient Information Forms.
  • Bring both your dental and medical insurance cards.
  • Nothing to eat or drink (including chewing gum and mints) past midnight the night prior to your appointment. If you take daily medications in the morning, please contact our office for additional instructions.
  • DO NOT smoke or use chewing tobacco the day of your procedure.
  • A responsible adult must accompany you, take you home, and stay with you for at least 6 hours after surgery. (You cannot drive a vehicle or operate machinery for 24 hours; you cannot walk, take a bus, or take a taxi home by yourself.)


Forms & Finance

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To reduce the amount of paperwork when you arrive for your visit, please complete our Patient Registration forms before arriving for your appointment and bring them with you. Whenever possible, we mail you these forms along with a detailed estimate prior to your surgery date so you can make appropriate financial arrangements before your visit. You may download and print copies of the Patient Registration Forms here on our website if you do not receive them by mail.

Patient Registration

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Online Registration


Dental Office Referral

Fill out and download the form below and send securely via email to mail@prairieoralsurgery.com or fax to 701.478.4407


For questions or assistance with referrals, please Contact Us


An estimated patient responsibility with be provided to you prior to surgery, we ask that you pay the estimated amount 10 days prior to surgery to secure your appointment. We do not offer financing through our office. However, we do accept Care Credit and Sunbit as outside financing options. For more information, the links for Care Credit and Sunbit are offered below.



See our Clinic

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At Prairie Oral Surgery we are proud to offer a warm, friendly, and comfortable atmosphere. Along with providing excellent treatment and surgical care, there are also many qualities that make our office inviting and unique. You will be greeted with a sincere smile, and feel a sense of relaxation from our 600 gallon salt water aquarium.

While you accompany your loved one to an appointment you will enjoy our coffee bar, televisions, free Wi-Fi, or kids play area in the lobby. Whether relaxing in the dental chair with the comfort of a heated blanket, or enjoying the view through our floor to ceiling windows in every room, we make every effort to make each person feel completely at ease.

We are conveniently located at the intersection of Interstate 94 and 25th Street, and we offer a 24 hour answering service for questions regarding your post-operative care.


Meet The Surgeons

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Corbett Haas, DDS, MD

Dr. Haas moved to Fargo in July 2018 following completion of his residency training in Boston, MA. He is originally from Anchorage, Alaska where he developed a love for hiking, salmon fishing and skiing as well as fanaticism for all Boston sports starting with the Red Sox at age 5 (his childhood Boston Terrier was named Nomar!). Following completion of his undergraduate training at University of Alaska Anchorage, he moved to Seattle, WA where he attended dental school at The University of Washington. After this, he completed a 1-year preliminary Oral and Maxillofacial Surgery internship at the prestigious Massachusetts General Hospital (MGH)

During this grueling year, Dr. Haas was formally accepted into the program and completed his residency training at the combined MGH/Harvard Medical School Oral and Maxillofacial Surgery Program. As part of this unique and comprehensive training, he received his Medical Degree from Harvard Medical School in May 2015. He also completed 2 years of accredited general surgery training and 5 months of general anesthesia training all at “The MGH”. Fun fact: in 1868, the first public demonstration of general anesthesia was performed at the MGH surgical amphitheater, now known as The Ether Dome. His oral surgical training was complete with an emphasis on corrective jaw surgery, trauma, dentoalveolar procedures, dental implants and safe and effective anesthesia. He is proud to bring what he has learned to Fargo where he continues to stay current and educated by way of continuing education and community involvement. He is board certified with the American Board of Oral and Maxillofacial Surgeons. 

In his free time, Dr. Haas enjoys spending time with his wife Rachel and their three kids, Isabel, Peter and Franklin, all of whom are under the age of 10. He has also developed a painful obsession with golf and can often be found in the woods of the Fargo/Moorhead golf courses searching for his lost golf balls. 

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Ryan Smart, DMD, MD, FACS

Dr. Smart grew up in the country in rural Montana and moved to Boston, Massachusetts where he received his dental degree from Tufts University School of Dental Medicine graduating Summa Cum Laude.  He was subsequently accepted into Harvard Medical School and the Massachusetts General Hospital Oral and Maxillofacial Surgery training program.  Upon completion of his medical degree and combined General Surgery/Oral & Maxillofacial Surgery training program, Dr. Smart went on to do further training at Louisiana State University, Shreveport, Louisiana to complete a fellowship in Head and Neck Oncology and Microvascular Reconstructive Surgery.  Dr. Smart is a Diplomate of the American Board of Oral and Maxillofacial Surgery, A Fellow of the American College of Surgeons and a Clinical Assistant Professor of Surgery at the University of North Dakota.  He has published over a dozen research articles, book chapters and has given several lectures around the United States and Fargo-Moorhead area.

Dr. Smart’s clinical interests include dental implants, management of wisdom teeth, tooth extraction, soft tissue and bone grafting, cosmetic facial surgery, including face and neck lift, rhinoplasty, facial implant therapy such as zygomatic and pterygoid implants as well as reconstructive surgery including major jaw, face, neck and scalp reconstruction.  He also treats head and neck cancer, benign jaw cysts and tumors as well as conditions of the temporomandibular joint (TMJ).  He uses 3D technology in dentistry and surgery for guided surgery, surgical navigation and custom reconstructive techniques.

Above all, Dr. Smart is an advocate for his patients and strives to partner with them in their treatment needs every step of the way while keeping his clients’ comfort and safety a top priority.

Dr. Smart resides in the Fargo-Moorhead area with his wife, Kim and two school-aged children.  He enjoys the outdoors, spending time with his family and martial arts.

For a complete look at Dr. Smart’s education and experience you can look through his Curriculum Vitae. 

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Dental Implants

A Dental implant is used as a tooth root substitute to replace damaged or missing teeth. A dental implant is a titanium screw that when placed in the jaw, forms a unique bond with your bone. After a specific healing period, your bone fuses to the implant. Dental implants can be used to replace a single tooth or as anchors to support multiple teeth.

An individual consultation with our surgeons will provide you with necessary information to make an informed decision if dental implants are right for you.


Wisdom Teeth

Wisdom teeth are your third molars; they are the last teeth to develop. Many times third molars do not have enough room to fully erupt; therefore, they can cause symptoms such as pain, swelling, and infection. Third molars are often difficult to clean properly and can be prone to decay. Your dentist may recommend removal of your third molars by our surgeons to prevent or treat symptoms caused by your third molars.

On the day of your appointment, our doctors will explain the procedure and answer any questions you may have.


Surgical Removal of Teeth (Single & Multiple)

You may be referred by your dentist to our sugeons for a tooth extraction due to their training and surgical experience. There are multiple reasons why your dentist may have referred you to our office for what may see like a “routine” extraction. Some of these reasons may be unique medical concerns, fractured teeth, infections and/or challenging extractions.


Lumps, Bumps, and Lesions

If you or your dental professional notice any unusual lumps, bumps, white patches, red patches, or sores that won’t heal; you may be referred to us for an evaluation. We have a fellowship trained surgical oncologist and reconstructive surgeon who can evaluate and treat benign and cancerous lesions of the head and neck.



Our surgeons specialized education as oral surgeons includes specific training in multiple types of anesthesia. During your procedure, one or more of the following types of anesthesia may be used to control your discomfort and anxiety: local anesthesia, nitrous oxide-oxygen, intravenous sedation, and general anesthesia. The type of anesthesia for your procedure will be determined based on your specific needs.


Remote video URL
Dental Implant Surgery


Remote video URL
Wisdom Teeth Treatment


Contact Us

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Prairie Oral Surgery
2585 23rd Ave South, Suite A
Fargo, ND 58103

Local: 1-701-478-4404
Toll Free: 1-866-478-4404
Fax: 1-701-478-4407

Monday-Friday - 8am-5pm


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