Broker Supply Request

Name: Broker Number:

Group # you are requesting information for Plan:

Address:

Address 2:

City:

State: Zip Code:

Phone Number: Email Address:

Yes, I would like to be added to your e-mail list to receive free ToothTips and Dental Health Insider Newsletters.

Supplies

SmartSmile Brochure

Group Information

Provider Directories

Enrollment Kits
(brochure, copay schedule, enrollment form, Provider Directory)

(Let us know if you would like your supply request shipped to a different address)Notes:

In this section:

Document Downloads
Forms
Links

From their own mouth.

"The value of a Dental Health Services dental plan is not just in its price, but in the intangible benefits - the 'extra mile' feeling that makes the client, broker and Dental Health Services have a win-win-win partnership."
- Lynn Arthurs - LFA Insurance Services, Inc.

Broker Supply Request

In this section:

From their own mouth.

Dental Health Services

UTU-MTA