If you have checked our Delta Dentist Locator and found that your provider is not a Delta Dental member, please provide answers to the questions below and send it to us via e-mail. Dentists accepted by Delta Dental must first meet certain qualifying criteria. Thank you for your recommendation and interest in Delta Dental.

To refer your dentist to Delta Dental, please provide the following information:

Your Name
Company You Work For
Dentist's Name
Address
City
State		ZIP
Phone
Specialty (if applicable)
I would like the dentist to join:	Delta Dental Premier Delta Dental PPO DeltaCare
Additional comments (optional):

 

Is it okay for us to use your name when contacting the dentist?

Yes - you may mention my name.
No - I prefer you not to mention my name.