The Forms Most Commonly Used By Savon Dental Plan Providers

All but one of these forms are in a PDF format, so you need to have Adobe® Acrobat Reader.  If you do not have it, you may download it for free at www.acrobat.com.

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Completed forms may be faxed to Savon at 602-589-0417 or scanned and emailed to ProviderServices@SavonDentalPlan.com.

Existing Providers Only - Add new dental centers and dentists (General and Specialists)
Add another General Dentist and facility
Add a General Dentist to an existing facility
Add another Specialist and speciality facility
Add a Specialist to an existing speciality facility
Urban and Rural fee schedules for each state
Download the official, full color Schedule of Benefits for your State
Used for fee schedule updates - survey in progress until June 01, 2021
Download the fee schedule update survey in Excel format
Open and save the fee schedule update survey in PDF format

Have a question or comment?  Email provider services, call us at 1-800-809-3494 or click the live help button at the top of this page.