Become a Dental Provider

Thank you for your interest in becoming an Envolve Benefit Options Dental Provider. We are excited to have you join our dental family. Please click below for your state credentialing packet to become an Envolve Dental provider. If you are already credentialed and need to update your Disclosure of Ownership form only, click here

Network Documents

Arkansas Packet

Arizona Packet

Florida Packet

Georgia Peach State (Ambetter Only) Packet

Kansas Packet

Illinois Packet

Indiana Packet

Louisiana Packet

Michigan Packet

Missouri Packet

Mississippi Packet

Nevada Packet (2 parts)

Part 1 Nevada Application

Part 2 Nevada Packet

New Mexico Packet

North Carolina Packet

Ohio Packet

Oregon Packet

Pennsylvania Packet

South Carolina Packet

Texas Packet

Wisconsin Packet

 

The following information is needed to process your request for panel participation. Please complete this form below for our Network Management Department.

Products you are interested in participating with:*

Please provide an Email address and Phone number we can contact you  in response to your request.

Upon receipt of your request for participation, a Provider Participation Agreement (PPA) & Fee Schedules will be mailed to your office for your review and execution.