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
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.

Provider First Name *

Provider Last Name *

CAQH #

Products you are interested in participating with:*

All Products Medicaid Medicare Commercial Health Insurance Marketplace

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

Contact Phone *

Contact Email *

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.