Delta Dental - Dentists - Customer Service

If you have a question regarding a claim or patient's eligibility please take a moment to complete the requested information. It will help our Customer Service representative respond quickly and accurately.
* = Required Fields

1. Please complete the following:

Dentist/Dental Office Name: *

2. Please complete the below information to verify claim payment, and/or coverage limitations.

Subscriber ID number * ###-##-#### (This is a nine digit number located under the member’s name on the Delta Dental ID card.) Please note, in order to protect our member’s privacy, as of June 2007 we no longer use Social Security Number as a Subscriber ID.	--
Name of member who received care: *
Date of Service: *
Group Number: *
Subscriber's Name: *
Employer's Name: *
Birth Date: *

3. Please briefly explain your request.

4. Your Telephone Number: * ()-

5. Your E-mail Address: *