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Get Dentaquest Appeal Form

G out this form, please contact our Customer Service Call Center. Member Toll Free: 800-516-0165 Provider Toll Free: 800-896-2374 ! Member Person filing appeal Type of appeal would you like to file ! Written Hearing Impaired: TTY 800-855-2880 ! Provider ! In-Person ! Member Name Provider Name Member Identification Number Provider License Number Telephone Number National Provider Identifier Address Telephone Number City Address State Zip City State Zip Please explain your appe.

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