TDP Dentists Applications and Agreements

United Concordia welcomes the opportunity to partner with you and your dental office and invites you to become a member of our growing network of dental providers.

The forms below are provided for your convenience in becoming a participating dentist with United Concordia. To apply for participation with United Concordia, you will need to do the following :

1. Print a TDP Addendum (this is for your records)
2. Fill out a Participation Agreement
3. Fill out a Participation Application

Completed Participation Agreement and Application should be mailed or faxed to :

Please note, these forms are in a pdf printable format. You will need Adobe Acrobat Reader version 4.0 or higher for your computer to print these enrollment forms. To get Acrobat, just click on the "Get Acrobat" button.

The Participation Agreements and Applications are State specific. Please choose from the state dropdown list below to obtain the correct application and agreement for your dental practice.

TDP and DoD Addendums

Participation Agreement

Participation Application