Customer Service Inquiry Form

At Delta Dental of Illinois, we're dedicated to providing exceptional customer service and resolving any issues or concerns you may have. Your satisfaction is our top priority, and we're here to help. Please take a moment to fill out the customer service inquiry form below with details about your query.

Once you submit your inquiry, you can expect a response from our Customer Service team within 1-2 business days.

All fields marked with * are required.

Topic

I need help with: *

Description: *

Contact Information

Full Name: *

Email: *

Phone:

Address Line 1:

Address Line 2:

City:

State: *

Zip Code:

Primary Policyholder's Information

Primary Policyholder Full Name: *

Username:

Member ID: (Note: please do not enter your Social Security Number as your Member ID)

Employer/Group Name: *

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Customer Service Inquiry Form

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