Update Your Office Information

Dentists Name: Office Phone: Fax Number: Date of Birth: (mm/dd/yyyy) Last Four digits of Social Security Number: Address: City: State/Zip: Email (required): Name of Office for Check Writing Purposes: Name: Address: City State/Zip: Federal Tax ID of Dentist/Practice for income tax purposes: Do you practice as part of a group or corporate office? Yes No If yes, please list names of corporation and Associate Dentists: Do you deliver care at more than on site? Yes No If yes please list: Effective Date of Change:

 

Superior Direct Connect provides members, dentists and benefit administrators with direct access to our system to check claim status, verify benefit eligibility, request EOB’s, add or update employee records, as well as request new ID cards.  All of these capabilities and more are just a click away!