Select your Plan:
Healthy Families Los Angeles County Medi-Cal Sacramento County Medi-Cal
Select your Plan:
Healthy Families Los Angeles Medi-Cal Sacramento Medi-Cal

Providers: Join The Health Net Dental Network

Please complete, sign, and date an application (PDF) (required for all practicing Dentists and Associates)

Please submit current credentials (required for all practicing Dentists and Associates)
General Dentist
- Wallet size Dental License
- DEA Certificate
- Professional Liability
- W-9 form

Specialists
- Please also submit Specialty Certificate(s)

Mail forms to:
Provider Relations
340 Commerce, Suite 100
Irvine, CA 92602
(888) 273-2713

1. User Name
2. Password
Register Now

Select your Plan:

Select your Plan:

Providers: Join The Health Net Dental Network