Join Our Dental Networks

Joining the EmblemHealth dental networks is easy. If you’re already credentialed by Dentistat, our credentialing verification vendor, you can become a network participant within three to four weeks of the date we receive all your completed paperwork. If you are not credentialed and would like to become part of our networks, please complete a Dentistat agreement in addition to the application and signed contract.

To apply for our networks:

1) Complete or provide the following application materials:

Application Materials Download (PDF)
EmblemHealth Dental Application Download (PDF)
Dentistat, Inc. Standard Participation Agreement Download (PDF)
Form W-9 Download (PDF)

A copy of your Professional Liability Insurance pages (not general) showing name and address of carrier, individuals covered, expiration date and liability limits.

If you are a solo practitioner, also complete:

Individual Dentist Contract Signature Page Download (PDF)

If you are a group practice with three or more providers, also complete:

Application Materials for Group Practice Download (PDF)
Group Contract Signature Page Download (PDF)
Addendum List for Associates Download (PDF)

2) Return all documents to us either by:

  • Mail:

    EmblemHealth
    Dental Provider Operations
    PO Box 12365
    Albany, NY 12214-5558

  • Fax: 1-212-615-4953 (downstate) or 1-518-446-0185 (upstate)
  • E-mail: dentalproviders@emblemhealth.com