Need immediate assistance? Call us at 800-762-3159 or use our online chat service:
CONTACT SDC
Contact Reason:
- Please Select -
*
Company Name:
*
Office Name:
*
Dentist Name:
*
Specialty:
*
Policy Holder Name:
*
Patient Name:
*
Member ID:
*
Date of Birth:
*
*
Procedure:
*
Network or Non Network Dentist:
Network dentist
Non network dentist
*
Address:
*
Email:
*
*
Telephone:
*
Comments:
Please do not send personal or sensitive information to us using this form, as it is generally not secure
*