How do I terminate network affiliation?

June 25, 2015

All requests must be submitted in writing on your company letterhead. There is a 90 day termination period during which time the provider is responsible for contacting all existing patients who may be affected.  Upon receipt of the termination request, the Provider will no longer be listed in the Dental Select Provider Directories for that specific plan or plans. You may fax, mail or email your requests – please locate the contact information below.