Please complete the appropriate application and provider agreement(s) below based on your state of business and the network(s) you are interested in joining. If you are interested in learning more about becoming a participating dentist, please contact our Professional Services Department directly at 888.471.3631.
Provider Applications
CT | DC | DE | MA | MD | OR | PA | VA | WA
Provider Applications
CT | DC | DE | MA | MD | OR | PA | VA | WA
Select Plan (DHMO) Provider Agreement
DC: General Dentists | Specialists | Orthodontists
DE: General Dentists | Specialists | Orthodontists
MD: General Dentists | Specialists | Orthodontists
NJ: General Dentists | Specialists | Orthodontists
PA: General Dentists | Specialists | Orthodontists
VA: General Dentists | Specialists | Orthodontists
PPO Provider Agreement
CT | DC | DE | MA | MD | OR | PA | VA | WA
Medicare Advantage Addendum