Nominate a Dentist

If your dentist is not listed in The Dental Care Plus Group's online directory, please fill out this nomination form so we may contact your dentist and invite him/her to start the process of joining our networks.

Please enter your dentist's name
Dentist's Name:
Please enter an address
Address 1:
Address 2:
Please enter a city
Please select a state
City: State:
Please enter a zip code
Please enter a county
Zip: County:
Please enter your name
Your Name:
Please enter your employer
Your Employer: (do not abbreviate)
Please select a date
Date of Enrollment Meeting or Today's Date:
May we use your name in our recruiting efforts with your dentist?
- Yes
- No

Download a Provider Nomination Form

If you would prefer to download the nomination form to either print or email, click here. Hard-copy nomination forms can be faxed to (513) 618-3881, Attention: Provider Recruiting and Contracting. Completed forms can also be emailed to: providerrelations@dentalcareplus.com.

The completion of this form, whether online, faxed or emailed, 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

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Nominate a Dentist

Download a Provider Nomination Form