Want to Enroll in our Dental Plan?

Join Now

Here is how:

• Select an available provider office from our Doctors page

• Review our Plan Brochure

• Download, complete and sign the Enrollment Form  (Click Here)

• Download, complete and sign the Credit Card Authorization Form  (Click Here)

• Mail your Enrollment Form with a check or money order made payable to Dedicated Dental, for the appropriate premium amount, plus a one-time $10.00 enrollment fee to the address on the form.

  ---

  Individual Plan Annual Rates:
  

  1200 Plan	Single	Single +1 Dependent	Family of 3 or 4	Family of 5+
  	$60	$120	$144	$180

  ---

• You may also visit one of our Dedicated Dental offices for same-day sign up.

Your membership becomes effective the date your application & payment are received in our corporate office.

Please call our Member Services Dept. at 1-800-277-1112 for any questions or to request an
enrollment form

Grievance Form

California Residents: Click here for information on how to file a grievance and for information on the Language Assistance Program.

Residentes de California: Haga clic aqui para información sobre comó archivar un agravio y para acceder al programa de asistencia de lenguaje.