Thanks you for inquiring about the Dental Plans being offered through DentaLink USA.
So that we can send you the proper plan information, we need to know how you heard about our plans, and your mailing address. If you are moving, please indicate your destination sate in the Border State area of the form.
Please select the sponsoring organization that you are a member of, or the best description of how you heard about DentaLink. Note: If you are a member of the Pentagon Federal Credit Union, Please CLICK HERE.
Sponsoring Organization
Name:
Address:
City:
State:
Border State:
Zip:
Sponsor, if Not listed:
Additional Information and/or remarks.
Email Address:
Remarks:
If you are near a state border, indicate the border state and we will include provider information for the indicated state..
Note also that if you are moving indicate the state you are moving to and include this information in the remarks section of this form.
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