Delta Dental of New Mexico

Forms

At Delta Dental, we want to make selling our products as simple as possible. We have made available for download important forms to ensure you have everything you need just a click away.
 

Agent Agreement Packet 

Agent Agreement Addendum

Form W-9 

  • Note: You can fill out most of this form on a computer. However, you will need to print it, sign it, and then return a paper or scanned copy to Delta Dental of New Mexico.


Employer Subgroup Information Page and Application Addendum

Individual Authorization Form

ACH Authorization

Claim Form

Dental Claim Form: To access a dental claim form, enrollees can log into Consumer Toolkit. They can also call Customer Service at (877) 395-9420 or send an email to customerservice@deltadentalnm.com to request a dental claim form.
 
Mail completed claims to:
 
Delta Dental of New Mexico
100 Sun Avenue NE, Suite 400
Albuquerque, NM 87109
 

If the information you are looking for is not available here, contact your Account Manager.
 

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