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 WellCare Medicaid 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.