Delta Dental of Arizona   (Select your state)
   | Register / Sign In |   


Arizona Dentists
Dentist Home  |Dentist Connection  |Dentist Resources  |FAQs  |Forms & Documents  |Contact Us  

PPO Fee Schedules

PPO Fee Schedule reports are generated Monday - Friday during normal business hours. If you do not receive the report email from Delta Dental of Arizona within 24 hours, please check your spam or trash folders to verify if the email was wrongly classified as junk mail.

If your office offers multiple specialties, you will need to complete this form for each specialty.

All fields are required.

Business Tax ID
(numbers only) 

 
AZ License ID
(numbers only) 

 
Office Street Address 

 
 Sample: 12345 N 7TH AVE STE 123
11811 E MCDOWELL RD STE 101

Provider Specialty 

 
Authorized First Name 

 
Authorized Last Name 

 
Enter Email 

 
Confirm Email 

 


Please enter the form authorization code in the text box below.

 

Hints:

  • If you encounter an error, click the "RESET" button to clear the page history and begin again.
  • Numeric values: Dashes, slashes, dollar signs and commas are assumed and not needed for entry.
  • Addresses: Common items should be abbreviated. For example, N (North), S (South), E (East), W (West), St (Street), Ste (Suite), 1st, 2nd, etc.
The Foundation
Promoting dental care for those in need.

Delta Dental of AZ Blog
News & tips to keep your smile healthy.

Customer Service
We're here to help.

Shop for PlansIndividuals & FamiliesEmployer/Group PlansVision PlansAffordable Care Act — Individuals and SHOPSelect your state
Provider SearchFind a Network DentistFind a Vision Provider
About Delta DentalCompany ProfileBoard of DirectorsExecutive TeamIn the NewsIn the CommunityCareer OpportunitiesNotice of Privacy Practices
The FoundationBoard of DirectorsGrantsFoundation Annual ReportDonate
Contact UsCustomer ServiceMedia RelationsDDAZ FoundationSales TeamSocial MediaCompliance