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Provider Inquiry Form

At Delta Dental of Illinois, we're dedicated to providing exceptional customer service so you can continue providing excellent patient care. Your satisfaction is our top priority, and we're here to help.

Please take a moment to fill out the provider inquiry form below with details about your query. Whether you have questions about claims and coverage, need assistance with your account, or simply want to provide feedback, we're eager to hear from you.

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

Thank you for choosing Delta Dental of Illinois. We appreciate the opportunity to serve you and look forward to assisting you soon!

All fields marked with * are required.

Topic

I need help with: *

Description: *

Contact Information

First Name: *

Last Name: *

Dental Office Name: *

TIN (Tax ID Number) *

Email: *

Phone:

Address Line 1:

Address Line 2:

City:

State: *

Zip Code: *

Primary Policyholder's Information

Primary Policyholder Full Name:

Employer/Group Name:

Member ID: (Note: please do not provide SSN)

Group Number:

Claim Number:

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Provider Inquiry Form

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