Update Your Information

Let us know in writing when you change your address; sell, buy, open or close an office; and/or change your Tax Identification Number (TIN).

Download Forms

Requires Adobe Acrobat Reader.

• Notice of Address Change
• Notice of Sale of Practice
• TIN form

How to Submit

Mail or fax completed forms to your local Delta Dental:

Delta Dental of California

Or fax to: 916-852-8995

Delta Dental Insurance Company

For the states of Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas and Utah

Or fax to: 770-641-5395

Mid-Atlantic Region

(includes Delta Dental of Pennsylvania (Pennsylvania and /Maryland), Delta Dental of Delaware, Delta Dental of the District of Columbia, Delta Dental of New York, and Delta Dental of West Virginia)

Or fax to: 717-774-1770