Anthem Stand-Alone Dental	Application
Individual Dental Blue	Application

Anthem Dental utilizes network and non-network benefits.

Please mail or fax your completed application to the address below.

Have Questions?  Please contact us:                                                 
       Right Track Benefits

            Joanie M. Streets

          Director of Individual Business

        7575 Fredle Dr. Suite 202

       Concord, OH 44077

       Phone (440) 357-9993

       Fax (440) 358-0058