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Dental Source :: Dental Health Care Plans *If you're looking for an individual policy Dental Source currently offers Plan E only If you have any questions please feel free to contact Dental Source at (866) 481-9473
Dental Source of MO KS, Inc Lab and sterilization fees are not covered by the Dental Source Program Specialist services are available in most areas and include Orthodontics, Endodontics, Periodontics, Pedodontics and Oral Surgery
Dental Source In the event of a dental emergency, Dental Source members should contact their selected Dental Source provider If the Dental Source provider is unavailable for emergency care within 24 hours, members may obtain emergency services from any licensed dentist The covered emergency services include palliative treatment to control pain,
Enrollment Application Other Important Questions Dental Source Applications received by Dental Source on or before the 25th of the month will be effective on the 1st day of the following month Contact our customer service department for confirmation before scheduling a dental appointment Can I change dentists? Yes you can As long as there is not a balance due to your current dentist, you can select another
Dental Source of Missouri Kansas State of Missouri Premiere Plan (100 . . . Dental Source of Missouri Kansas State of Missouri Premiere Plan (100 80 50) dental plan must have been in effect continuously for at least 12 All employees insured on the effective date with continuous 3 A minimum of three (3) enrolled members are needed for an
DENTAL SOURCE DENTIST REFERRAL FORM Dental Health Care Plans a dba of MNM-1997, Inc 101 Parklane Blvd , Suite 301 Sugar Land, TX 77478 (866) 481-9473 Fax (281) 313-7155 DENTAL SOURCE DENTIST REFERRAL FORM Your Name: Your Phone Number: Your Email Address: Are you a Dental Source member? YES NO
Dental Source a dba of MNM-1997, Inc. State Employee Toll Free 1-866 . . . Dental Source a dba of MNM-1997, Inc State Employee For Office Use Only: Toll Free 1-866-481-9473 Enrollment Form DS 1D DSB1D DSP1D DPA1D www densource com DS 2D DSB2D DSP2D DPA2D REQUIRED (Your Department and Division Name): Part 1 Effective Date: 2 SOCIAL SECURITY NUMBER 3 NAME (LAST) (FIRST)
Dental Source The American Dental Association (ADA) assigns code numbers to each dental service The Schedule of Services below provides you with an easy reference to the coverage associated with the Dental Source Program