Provider Contracting

Thank you for your interest in becoming a Capitol Dental Care Preferred Provider. Please complete the Prospective Provider Form below and submit it to Provider Services for consideration. You will be notified once we have evaluated the need for additional providers. If Capitol Dental Care moves forward with contracting, we will begin the credentialing process at that time.

Please email the Prospective Provider Form and any inquiries to Providers@capitoldentalcare.com

Prospective Provider Form

Please Be Aware

• Completing a Prospective Provider Form does not guarantee network participation.
• If you have treated Capitol Dental Care members but have not obtained a prior authorization, services may not be reimbursed, and per OAR 410-120-1280, the member may not be billed.
• Until you have contracted with Capital Dental Care, all Capitol Dental Care members should be referred to member services at 1-800-525-6800 or members@capitoldentalcare.com