Background and objectives: Dental appointment keeping is an important aspect of patient care, influencing the effectiveness of health care delivery. Since this behavior is setting-specific, a gap in knowledge is observed on the barriers to appointment keeping in a dental tertiary care center. Therefore, a sequential mixed method study was adopted to explore the barriers governing dental appointment keeping among patients reporting to a tertiary care setting and to assess the prevalence of missed dental appointments in a tertiary care center. Methodology: Quantitative data recorded six months of retrospective data on missed appointments in the center. Prevalence was estimated in percentages, and descriptive statistics were used to summarize data. The Chi-square test was used to determine the association between categorical variables. For the qualitative arm, focus group Discussions and in-depth interviews were conducted among dental health professionals and patients. Data were transcribed, and thematic content analysis was performed using NVivo software. Results: The prevalence of missed appointments in the tertiary care center was reported to be 8.4%. Education was negatively correlated with missed appointment rates. Barriers identified for appointment keeping include personal/health issues, socioeconomic status, health system, communication, and accessibility barriers. Qualitative data revealed information on the appointment systems, experiences, consequences, responsible factors, management, and prevention of missed appointments in a tertiary care dental center. Conclusions: and recommendations: Multiple barriers to dental appointment keeping in the tertiary care center are identified. Missed appointments are prevalent in the study setting, as dental treatments require multiple sittings to complete. Tailor-made interventions are suggested for tertiary care settings to manage and prevent missed appointments, thereby paving the way for successful health care delivery.