Contact
Your Provider Relations Department Representative
| Practice Area |
Contact |
| Ohio or the Kentucky Counties of Boone, Campbell,
Kenton and Pendleton |
Malinda Eisenmann
513-554-1100 |
1-800-367-9466 |
| Kentucky (outside of the Northern Kentucky communities
listed above) or Southwestern Indiana |
Melissa Wilson
513-554-1100 |
1-800-367-9466 |
Download the - Network
Application Form (pdf) and IRS W-9 Form (pdf)
Completed Application Forms should be mailed along
with copies of your state license, DEA certification
(if applicable), Professional Liability/Insurance Declaration
Page and W-9 to:
The
Dental Care Plus Group
Attention: Provider Relations
Network Applications
100 Crowne Point Place
Cincinnati,
OH 45241
|