Please select the company through which you receive your benefits Delta Dental of California (California) Please select your plan type: Delta Dental Premier ® and Delta Dental PPO TM DeltaCare ® USA Inquiries Delta Dental Insurance Company (Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas and Utah) Please select your plan type: Delta Dental Premier ® and Delta Dental PPO/DPO TM DeltaCare ® USA Inquiries Mid-Atlantic States (Delta Dental Delaware, Inc., Delta Dental of the District of Columbia, Delta Dental of New York, Inc., Delta Dental of Pennsylvania (and Maryland), Delta Dental of West Virginia, Inc.) Please select your plan type: Delta Dental Premier ® and Delta Dental PPO TM DeltaCare ® USA Inquiries CUSTOMER SERVICE REQUEST *Enrollee First Name Patient First Name *Enrollee Last Name Patient Last Name *Enrollee ID Patient Date of Birth *Enrollee Date of Birth Form Submitted by What can we help you with? *Type of Request -Select- Eligibility Benefits Claims Orthodontic Information Waiting Period ID Card Billing Statement Policy Reinstatement Policy Cancellation Evidence of Coverage Provider Directory Refund Request Facility Change Change Personal Information Other *More detail: *Email (Where we will reply to you about this request) Submit Cancel