Join Our Network
Please complete the appropriate application and provider agreement(s) below based on your state of business and the network(s) you are interested in joining.
If you are interested in learning more about becoming a participating dentist, please contact our Professional Services Department directly at 888.471.3631.
Provider Applications
Select Plan (DHMO) Provider Agreement
PPO Provider Agreement
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Medicare Advantage Addendum
Download
Third-Party Access
Dominion enters into agreements that grant certain third parties access to Dominion’s network dentists, in accordance with Dominion’s agreements with its network dentists.
Network dentists who do not want to participate in such third-party access should notify Dominion at ProviderApps@dominionnational.com or 888.518.5338.
The following third parties have access to Dominion’s network dentists:
- BlueKC (Missouri)
- Capital Blue Cross (Pennsylvania)
- CarePartners of Connecticut (Connecticut)
- CommunityCare (Oklahoma)
- Cox Health Plan (Missouri)
- Humana (Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, Virginia)
- Independence Blue Cross (Pennsylvania)
- AmeriHealth (New Jersey)
- Point32Health (Maine, Massachusetts, New Hampshire, Rhode Island)
- Providence Health Plan (Oregon, Washington)
- Tufts Health Plan (Massachusetts)
Last Updated October 30, 2024