Nominate a Provider

If you are a member of FCL Dental, you can save on your out-of-pocket costs by visiting a dentist who participates in the FCL Dental Networks.

Is your dentist missing from our network?

We don’t want you to have to choose between continuing to see your dentist and receiving the best possible value from your dental benefit plan. You can help us get your dentist on our participation list.

Simply complete the information below. We’ll invite your dentist to participate in the FCL Dental Network. If your dentist joins, you’ll be sure to save!

Dentist or Practice Name *

Dentist or Practice Name is required.

Dentist or Practice Address *

Dentist or Practice Address is required.

City *

City is required.

State *

State is required.

Telephone *

Telephone is required.

Website

Your Name *

Your Name is required.

Your Email Address *

Your Email Address is required.

Are you a current member or provider? *

Current Member

Provider

Neither

Select if you are a Current Member, Provider, or Neither.

Type the code from the image *

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* - Required Field