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:

• Individual Dentist Contract Signature Page

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

• Group Contract Signature Page
• Addendum List for Associates

2) Return all documents to us either by:

• E-mail: dentalproviders@emblemhealth.com
• Mail:

  EmblemHealth
  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)