TRICARE Retiree Dental Program (TRDP)
 Online Dentist Inquiry Form

Are you a subscriber? Please use our Online Customer Service Inquiry Form.

REQUESTOR INFORMATION

Required fields are denoted by a red asterisk (*).

 
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* USA: (xxx) xxx-xxxx
USA: (xxx) xxx-xxxx
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NATURE OF INQUIRY

* A selection is required.

Enrollment and/or benefits.
Please provide the following information on the subscriber. If the patient is not the subscriber, enter the patient name (First and Last) and patient’s date of birth in the Inquiry Details area below.
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  * / / MM/DD/YYYY
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(9-digit SSN or 11-digit Defense Benefits Number, excluding hyphens and spaces)
 
A processed claim.
Please provide your Claim Number. Enter related comments in the Inquiry Details area below.
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The 13-digit Claim Number is located in the upper right portion of your Explanation of Benefits.
 
Response to Information Request letter.
Please provide your Claim Number. Enter related comments in the Inquiry Details area below.
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The 13-digit Claim Number is located in the upper right portion of your Information Request letter.
 
I am interested in participating in the TRDP network.
Enter related comments in the Inquiry Details area below.
 
I am a Delta Dental network dentist and I have a question regarding participation in the TRDP network.
Enter related comments in the Inquiry Details area below.
 
I am a Delta Dental network dentist and I have changed my office information.
Enter related comments in the Inquiry Details area below.

INQUIRY DETAILS

* Inquiry details are required.

Attachments

Only one file may be attached per inquiry. Maximum file size is 15MB.
Accepted file types are doc, docx, xls, xlsx, xlsm, pdf, txt, jpg, jpeg, tif and tiff.

 

Security Question

Select one verification method     
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