Delta Dental Patient Direct

Step 1: Enrollment

Clear Enrollment

Delta Dental Patient Direct is a discount dental program that provides Oklahoma residents with competitive rates for specific dental services performed by dentists participating in the Patient Direct Network. Patient Direct is not dental insurance. You simply pay a discounted fee at the time of treatment.

To be eligible for Patient Direct you must:

Live in the state of Oklahoma
Be over 18 years of age

To enroll in the Delta Dental Patient Direct program, complete the information below, proceed to our secure payment portal on the next page to submit payment and complete your enrollment. All enrollments will be processed the following business day.

If you have any questions, please contact our Customer Service team at 405-607-4700 (OKC Metro) or 877-433-5821 (Toll Free).

Broker/Agent:
Code:
If you have been provided a broker or agent code, enter it here.
Select Plan: *
Please select the approriate plan type below.
	Individual - $60.00 Family - $84.00

Name:
First Name:	*
Middle Name:
Last Name:	*
Mailing Address:
Line 1:	*
Line 2:
City:	*
State:	*
Zip:	*

Contact Information:
Day Phone:	() - *
Evening Phone:	() -
Fax:	() -

Member Information:
SSN:	- - *
Date of Birth:	/ / *
	(mm/dd/yyyy)

Security:

Create a username and password to access your Delta Dental Patient Direct account.

Password Requirements
1. Password must be between 6 to 25 characters.
2. Password must have at least 2 numeric characters.
3. Password can not have special characters listed below:
'%', '(', ')', '*', '\', '&', '#'

User Name:	*
Password:	*
Confirm Password:	*
Password Question:	*
Answer:	*

Email:	*
	A valid email address is required.
Confirm Email:	*
	Do not send me emails that are not related to my Patient Direct membership.