Please complete the below form with your new insurance information. Your insurance information will be submitted to Research Triangle Dental and applied to your record.

Please check this box if you are the policy holder (subscriber) for your insurance. If you are not the policy holder of your dental plan, please enter the Subscriber information below.


Delta DentalBlue Cross Blue ShieldMetlifeAmeritasCignaAetnaGuardianHumanaGEHAUnited ConcordiaUnited HealthcareOther