Use this form to set up an online account for your new dental plan. Information should be entered for the primary person on the plan (the subscriber).
You will need your subscriber ID to register. You will find it on your purchase confirmation page. If you do not have it, please contact us at
email@example.com or by phone at 800-872-0500
Please enter the identification information for one of your dependents
Please enter your identification information as a head of household