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Tell us a little about yourself and one of our representatives will contact you.

For all other audiences, please visit contact us.

All information is required, unless marked optional.

Name

Name is required.

ZIP Code

Must use 5 or 9 digit number.

Your Email

Your Email is required.

Confirm Your Email

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Phone

Must use a 10 digit number.

Ext. (optional)

Ext cannot exceed 5 characters.

Reason

I want to join your network. (Check if you’re a new dentist or office joining United Concordia’s network.)

I want to add an additional office location to your network. (Check if your office is already participating and wants to add a new location.)

I want to add a new provider to our office. (Check if your office is already participating and wants to add a new associate.)

Reason is required.

How did you Hear about Us

How did you Hear about Us is required.

Additional Info (optional) Please provide any other details that can help us help you, i.e., doctor name(s), TIN, office name, communication preference, address, NPI.

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Let's talk partnership!

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Let's talk partnership!

Join our network

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Non-Discrimination Notice