Network Provider Application for Dentists

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Network Provider Application

The following "Network Provider Application" is for Dental or Dental Specialty Providers ONLY! If you are a consumer and you would like a specific dentist to be contacted regarding participation in one or more of our plans, click here!

If you are interested in becoming a Participating Provider in one or all of the discount dental plan(s), please fill out the following Network Provider Application. By doing so, your activation process will be expedited.

Please fill out the following application in order to get started:

Network Participating Provider Application

Dental Office Name:

Owned by:

Dentist's Full Name:

Email Address:

Street Address:

City:

State:

ZIP:

Business Phone:

Fax Number:


	I would be interested in creating a website for my practice.

I am interested in enhancing the marketing of my dental practice with postcards, tri-folds, web banners and more. Also, click on the "For Dentists" tab in the navigation above to learn more about the FREE DentalPlans.com Provider Marketing Program.

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The DENTALPLANS.COM website is administered by DENTALPLANS.COM, INC., a licensed Florida Discount Medical Plan Organization, 8100 S.W. 10th Street Suite #2000, Plantation, FL 33324. Plans and Programs offered by DentalPlans.com are not health insurance policies. Plans and Programs offered by DentalPlans.com provide discounts at certain health care providers for medical services. Plans and Programs offered by DentalPlans.com do not make payments directly to the providers of medical services. The Plan or Program member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the Plan, Program or discount plan organization.

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