Join the network where millions of members are waiting to access your practice.
Apply TodayCompleted, signed, and dated application (current version), including:
Completed, signed, and dated attestation within 120 days prior to submission, if applicable:
Completed, signed and dated Participating Provider Agreement:
Additional items that may be requested:
If you are in a state that uses mandated credentialing forms, your state is requiring you to use their form.
Step 1: Download your state's form by clicking the state name below.
Step 2: Download and fill out the Connection Dental Attestation form. (For Oklahoma applications only)
Step 3: Click this link to download the participating provider agreement.
Step 4: Collect any additional documents needed that are listed in your application.
Step 5: Visit our Contact page to obtain contact information for your state network representative. You can also fax your completed forms and documents to: (816) 257-4439.
Step 1: Click this link to download the Connection Dental Network Application
Step 2: Click this link to download the participating provider agreement.
Step 3: Collect any additional documents needed that are listed in your application.
Step 4: Visit our Contact page to obtain contact information for your state network representative. You can also fax your completed forms and documents to: (816) 257-4439.