DentalPlans.com > Help > 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: Individual Partnership Professional Corporation Dentist's Full Name:   Email Address: Street Address: City:     State: Select A State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 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.   Who currently handles the marketing in the practice? ? help Please enter numbers shown above

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