Customer Service Inquiry

The administering Delta Dental member company for the state of WA is: Washington Dental Service
	Customer Service Phone Number(s):    800-554-1907 E-mail:    portal@deltadentalwa.com Mailing Address:    P.O. Box 75983    Seattle,  WA  98175

Please feel free to contact this member company by entering and sending the information in the form below. Required fields are indicated with an asterisk (*).

Note: Please do not include protected health information when using this form.

1. What is it that you are inquiring about?

*Message:

2. Patient Information

First Name: Last Name: Group No: Claim No:

3. Who should we respond to?

*First Name: Middle Initial: *Last Name: Subscriber ID No:

4. What Employer/Group provides your dental benefits?

Employer/Group Name:

5. Where are you located?

Street Address: Street Address 2: City: *State: *Zip Code: Country:

6. How may we contact you?

*E-mail: *Daytime Phone:  -   -  Evening Phone:  -   -