Dentist Information Request

Step 1: The following online or automated services may have what you need. If not, go to Step 2.

Provider Tools:

Log in to your online account to:

  • Obtain a fee revision form (use My Contracted Fees) or status of a recent fee filing.
  • View current eligibility and benefits information, remaining maximums and deductibles, claim status and treatment history and/or enroll in direct deposit.

Automated telephone system:

Hear current eligibility and benefits information, or request faxes (there is no limit to the number of faxes you can request per call). Choose the Customer Service number for your region here: deltadentalins.com/about/contact.

Step 2 - Tell us how we can help.

What would you like to do? (Select one)

I'm looking for new business opportunities.

My current business information needs to be updated.

Please have a Delta Dental representative contact me about the following:

Step 3 - Please include all the information requested below.

1. Dentist to be contracted or whose information is to be changed:

2. Practice location to be contracted or affected by a change:

3. Additional information about the practice location to be contracted or affected by a change:

4. Your contact information:

Thank you! You'll hear from us soon.