Refer a Dental Provider

If you were unable to find your dentist of choice, use this form to refer him or her to the Principal Plan Dental Network. Each applicant is reviewed with respect to utilization profiles, malpractice coverage, history, licensing, and sanctions. Accepted providers are continually monitored to ensure a quality network.

* Required fields

Dentist's First Name *

Dentist's Last Name *

Dentist's Address *

Dentist's Specialty *

City *

State *

Zip *

Dentist's Phone Number *

Your Information

I am a *

Your Name

Let us tell your doctor how much you appreciate them. By sharing your name here, we're able to let him or her know you made the referral.

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