Nominate a Dentist

If your dentist is not in The Dental Care Plus Group Online Directory, please fill out the online nomination form below so we may contact your dentist and invite him/her to join our networks.

Dentist's Name:
Address 1:
Address 2:
City: State:
Zip: County:
Your Name:
Your Employer: (do not abbreviate)
Date of Enrollment Meeting or Today's Date:
May we use your name in our recruiting efforts with your dentist?
- Yes
- No

Download a Nomination Form

If you would prefer to download the nomination form to either print or email multiple copies, click here. Hard-copy nomination forms can be faxed to 513-618-3881, Attention: Provider Relations.

The completion of this form, whether online or faxed, is a request for The Dental Care Plus Group to begin the recruitment process with your dentist. Completing this form does not guarantee that your dentist will become a participating provider.

Download the Nominate a Dentist form (.pdf) >>

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Nominate a Dentist

Download a Nomination Form

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