Update Your Information

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

Download Forms

Requires Adobe Acrobat Reader.

Important note: If you change your TIN, you will need to re-register for Online Services with your new TIN.

How to Submit

Mail or email completed forms to your local Delta Dental:

Delta Dental of California

Delta Dental of California
ATTN: Provider Onboarding
P.O. Box 997330
Sacramento, CA 95899-7330

Delta Dental Insurance Company

For the states of Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas and Utah and U.S. Virgin Islands.

Delta Dental Insurance Company
ATTN: Provider Onboarding
P.O. Box 1826
Alpharetta, GA 30023

Mid-Atlantic Region

Includes Delta Dental of Pennsylvania (Pennsylvania and Maryland), Delta Dental of Delaware, Inc., Delta Dental of the District of Columbia, Delta Dental of New York, Inc., and Delta Dental of West Virginia, Inc.

Delta Dental of Pennsylvania
ATTN: Provider Onboarding
P.O. Box 2106
Mechanicsburg, PA 17055