Platinum Plus client base and membership continues to grow, driving volume and increasing exposure to the providers in our network. Let us get new dental patients in your door with this great discount dental plan. Sign up now to become a Platinum Plus Provider. If you are a general dentist, orthodontist, endodontist or oral surgeon, simply fill out the provider request form below to begin the process. A member of our team will be in contact with you.


Provider Participant Request


    Your First and Last Name (required)

    Select a Degree (required)

    Select a Specialty (required)

    Primary Practice Name (required)

    Primary Practice Address (required)

    Primary Practice City (required)

    Primary Practice State (required)

    Primary Practice Zip (required)

    Phone Number (required)

    Your Email (required)

    Additional information