Joining the EmblemHealth dental networks is easy. Complete the documents below to become a participating provider in our PPO Dental Networks.
To apply for our networks:
1) Complete or provide the following application materials:
- EmblemHealth Dental Application
- Form W-9
- 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:
If you are a group practice with three or more providers, also complete:
2) Return all documents to us either by:
- E-mail: firstname.lastname@example.org
Dental Network Development
PO Box 2818
New York, NY 10116
- Fax: (212)615-4953 (In NYC, Long Island, New Jersey, Westchester County or Rockland County)
or (212)510-5135 (In Upstate New York and Other States)