New to the network

Thank you for your interest in becoming a dental network provider. The first step is to let us know that you’d like to join our network.

Please click below to submit an online application:

General Dentists, Endodontist, Orthodontist, Periodontist, Pediatric Dentists and Oral Surgeons

Join our Network »

To prevent delays in processing, please be sure to include:

  • W-9
  • Provider roster
  • Document attachments in PDF format
  • Provider Add Form for each individual provider

After submitting an online application, what happens next?

  • Your application will be assigned to a contracting representative.
  • Your application will be reviewed within 30 business days.
  • Oral Surgeons require credentialing. You will be directed to submit credentialing applications.
  • After all required documents have been received and processed, contracts will be sent for your review and signature.
  • Once signed contracts are returned, they will be submitted to the network for final execution and an effective date.

Existing Network Providers

In order to help provide the highest quality of care to our members, our provider advocate team is available to support our network of providers. This includes onsite and telephonic access to address questions. To contact our provider advocate team, click here.

Requesting contract updates/changes?

If you’re an existing provider in the network but would like to request a change in your agreement, please send us a letter of intent by email at

Your letter of intent should include the following information:

  • Requested change
  • Provider/Group name
  • Tax ID
  • Group NPI
  • Roster (to include provider name, NPI, specialty, practice locations)
  • Practice locations

Existing group provider adds for general dentists, endodontics, orthodontists, periodontists and pediatric dentists do not require credentialing. Please submit a Provider Add Form to

Contact Us

To contact the Provider Services team, please call 702-242-7086 or email

New Dental Provider Letter of Intent Applications