Dental Provider Nomination Form

Love Your Out-of-Network Dentist?

If you want your dentist to participate with United Concordia, please complete the form below. Upon receiving your email, we will contact your dentist.

on card
  • If "XXX XX 1234" is displayed on your ID card, enter your full Social Security Number. Do not type the X's.
  • The Identification Number is the same for everyone covered on this policy.

Dentist Information

Help Us Help You!

Submit your dentist's information using our convenient form and we'll extend an offer to join our Advantage Plus network, which has over 80,000 dentists nationally. If your dentist chooses to join, your out-of-pocket costs will automatically be lowered.

On average, our members save more than $40* every time they are treated by any of our high quality, URAC certified network dentists.