Nominate your dentist for participation in the TRICARE Retiree Dental Program


If you are unable to find a TRDP network dentist, or your dentist is not currently in the TRDP network, use the form below to nominate your dentist for participation in the TRDP network.

Please note: Nomination does not necessarily result in participation. Dentist participation in the TRDP network is voluntary. Upon your nomination, Delta Dental will send your dentist a Participating Dentist Agreement form to sign and return only if he or she wishes to participate in the TRDP network.

* Indicates required fields.

Dentist's name*

Dentist's address 1*

Dentist's address 2


State* Zip*

Dentist's telephone* - -

Your name*

Your e-mail address (optional)