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This is not an
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ABOUT SSL CERTIFICATES


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Welcome! Delta Dental Patient Direct provides Oklahoma residents with competitive rates for specific dental procedures. Patient Direct is not insurance; it is a discount program only.

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, please complete the information below. You will also need to ‘Make a Payment’ on our secure payment portal at the bottom of the page in order to complete your enrollment. All enrollments will be processed on 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.


  
Name:
First Name: *
Middle Name:
Last Name: *
Mailing Address:
Line 1: *
Line 2:
City: *
State: *
Zip: *
Contact Information:
Day Phone: ()  - *
Evening Phone: ()  -
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: *  
 
Payment:


Your enrollment is not complete until you make a payment* on our secure payment portal.

*Credit Card transactions will be assessed a $3 convenience fee.

You will receive your enrollment information upon payment confirmation.
Acknowledgement and Authorization: By registering an account and clicking 'Make Payment.', I hereby affirm I am an authorized user of the account and acknowledge the information provided is accurate and correct to the best of my knowledge. To cover the cost of my dental discount program, I hereby authorize Delta Dental to draft my designated account until further notice. I understand and agree that failure to make funds available in sufficient amounts to cover the cost of my dental discount program shall result in the cancellation of my participation. By submitting this application, I agree to receive communication regarding my dental discount program electronically.

Warning: Any person who knowingly, and with intent to injure, defraud, or deceive any insurer, provides false information herein and makes any claim for the proceeds of this program containing any false, incomplete, or misleading information is guilty of a felony.

©2011 DDSC