logo

Join Our Team




Total Dental
Administrators, Inc.


Utah

6985 Union Park Center
Suite 675
Cottonwood Heights, UT 84047

Phone 801-268-9740
Fax 801-268-9873
Toll Free 800-880-3536

Arizona

2111 E. Highland Avenue
Suite 250
Phoenix, AZ 85016-4735

Phone 602-266-1995
Fax 602-266-1948
Toll Free 888-422-1995

Utah Provider Enrollment Forms

 

Please download the form appropriate to your specialty.

Utah DHMO Provider

Download DHMO Dentist Form

Utah PPO Provider - General Dentist

Download PPO General Dentist Form

Utah PPO Specialist - Endo / Perio / Oral Surgeon

Download PPO Endo Perio Oral Form

Utah PPO Specialist - Orthodontist

Download PPO Orthodontist Form

Utah PPO Specialist - Pediatric Dentist

Download PPO Pediatric Form