Join Our Dental Networks

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Join Our Dental Networks

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:

  • 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)