Thank you for your interest in joining the Connection Dental Network. In order to apply to be in the network, you must complete and sign both an Application and a Participating Provider Agreement, and submit any requested supporting documentation.

To view a Connection Dental Network Application or Attestation, you need the Acrobat Reader program. If you do not have Acrobat Reader, please click on the link provided below. The link will take you to the Acrobat Reader website and allow you to download Acrobat Reader free of charge.

State Mandated Applications*
Colorado
Louisiana (or use the CAQH Application)
Nevada
North Carolina
Oklahoma**
Oregon - Initial Credentialing
Oregon - Recredentialing
West Virginia - Initial Credentialing**
West Virginia - Recredentialing**
Mandated CAQH Applications*
Kentucky
Louisiana (or use the State Mandated Application)
Maryland
New Mexico
Ohio
Vermont

*Each credentialing application above should be used for both initial credentialing and recredentialing unless listed separately.

**Dentists must also complete the Connection Dental Network Attestation / Fillable Connection Dental Network Attestation and submit a copy of the completed, signed and dated Attestation with the State Credentialing Application for both Initial and Recredentialing.

Once you have completed the application, you can email all documents to the representative for your state. Click here and click on your state to obtain the email address and contact information for your state network representative. You may also fax the information to (816) 257-4439 or mail the information to:

GEHA/Connection Dental Network
P.O. Box 6707
Lee's Summit, MO 64064-6707