Use this form to request a printed dentist directory via postal mail or fax. To find your prospective dentist immediately, use our interactive Dental Directory.
Dentist directories are available for CIGNA Dental Care and PPO members only.
* Indicates required field
* First Name:
* Last Name:
* Daytime Phone:
Extension:
* E-mail Address:
(Please verify that your e-mail address is correct)
* Employee Name:
* CIGNA ID Number:
* Street Address:
* City:
* State:
* Zip/Postal Code:
* Coverage Type:
CIGNA Dental PPO
Unknown
* List dentists by (choose one):
City, State
City:
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25-Mile Radius of Zip Code
Zip Code:
* How would you like to receive your listing?
Fax
* Fax Number:
Mail
Send dentist directory to alternate address (check here):
* Please enter alternate mailing address:
Name:
Street Address:
State:
Zip/Postal Code: