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Get Dentaquest Orthoselect Form

DQ181(9/07)TBDM DentaQuest 4061 Powder Mill Road, Suite 325 Calverton, MD 20705-3149 Membership Form PRINT (Last) Name of Covered Individual (Print) Street Address City Social Security Number Date.

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How to fill out the Dentaquest Orthoselect Form online

Filling out the Dentaquest Orthoselect Form online can streamline your application process for orthodontic discounts. This guide will walk you through each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to fill out the Dentaquest Orthoselect Form.

  1. Click the ‘Get Form’ button to access the Dentaquest Orthoselect Form. This will allow you to open the form in your online editor.
  2. Begin by entering the name of the covered individual. Ensure you fill in their last name, first name, and middle initial correctly in the designated fields.
  3. Provide the street address of the covered individual, including the city, state, and zip code. Accuracy is important to ensure proper communication.
  4. Input the individual’s Social Security number. Please ensure this information is accurate to avoid processing delays.
  5. Enter the home telephone number and, if applicable, the work telephone number. This information may be used for follow-up purposes.
  6. Fill in the date of birth of the covered individual to verify eligibility and ensure proper processing.
  7. Complete the section for the name of the responsible party, mirroring the steps for the covered individual’s name entry.
  8. Indicate the relationship of the responsible party to the covered individual in the provided field. This helps clarify the responsible party's role.
  9. Select the method of payment by checking the appropriate box for either check, money order, or credit card. If using a credit card, complete the account number, name on the card, expiration date, and provide an authorized signature.
  10. Review all entered information for accuracy. Ensure that every field is filled out completely before proceeding.
  11. Save your completed form, then download or print it for your records. Finally, share or mail the form as instructed to DentaQuest at the provided address.

Complete your Dentaquest Orthoselect Form online today to secure your orthodontic discounts.

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Dental Corp is one of the prominent networks partnering with DentaQuest, with several locations across the country. They focus on providing high-quality dental care, making it easy for patients to seek treatment. Having such a large network means you can access a variety of services conveniently. Utilizing the DentaQuest Orthoselect Form can help guide you to a Dental Corp location near you.

DentaQuest USA is a comprehensive dental benefits company that provides coverage for millions of Americans. Their services include both preventive and restorative care, aimed at improving overall dental health. DentaQuest works alongside various partners, ensuring that people receive the best possible dental services. By using the DentaQuest Orthoselect Form, you can navigate your options and maximize your dental benefits effectively.

Specialty dental brands, including those affiliated with DentaQuest, feature numerous locations dedicated to specific services. These specialty practices focus on areas such as orthodontics, periodontics, and pediatric dentistry. The collaboration with DentaQuest enhances their capabilities, making it easier for you to access specialized dental care. When you fill out the DentaQuest Orthoselect Form, you can gain insights about these specialty options.

DentaQuest operates in multiple states across the United States, boasting a vast network of providers. Their commitment to accessibility means that they have thousands of participating dental locations. This extensive presence makes it easier for you to find a dental provider near you. Using the DentaQuest Orthoselect Form can help you connect with these providers and manage your dental benefits effectively.

DentaQuest has been a leader in dental benefits for over 30 years. The company was founded in 1996 and has grown significantly since then. They focus on increasing access to dental care and improving the health of communities. By providing the DentaQuest Orthoselect Form, they streamline processes for both patients and providers.

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