two great dental programs - kaiser permanente · 2019-10-03 · dentist (ppo dentist). if you...

Two great dental programsFor 2020 Kaiser Permanente Federal MembersYou must be enrolled in one of Kaiser Permanente’s medical plans to elect KPIC Dental Insurance Plan or DeltaCare® USA dental coverage

We keep you smiling®

Kaiser Permanente is pleased to offer Federal employees and eligible Federal retirees and dependents who are currently enrolled or planning to enroll in one of Kaiser Permanente’s medical plans a choice of the dental plans described below. Option 1 is a dental PPO plan underwritten by Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc., and is administered by Delta Dental of California (Delta Dental). Option 2 is a DeltaCare® USA dental HMO program provided by Delta Dental of California and administered by Delta Dental Insurance Company. (These companies are financially responsible for their own products.) These benefits are neither offered nor guaranteed under a contract with the Federal Employees Health Benefit (FEHB) Program, but are made available to all enrollees and family members who become members of Kaiser Permanente.

During the annual open enrollment period, you have the opportunity to enroll in one of the two plans. If you are already enrolled, you may change plans during this period. Your coverage under the enrolled plan will become effective on January 1, 2020 and will extend through December 31, 2020, subject to your continued premium payments and enrollment in Kaiser Permanente’s traditional HMO Plan. If you are already enrolled under one of the two dental plans and are not planning on changing your coverage, you do not need to complete the enrollment form. If you are changing plans, you must provide 30‑days advance written notice of termination. If you are covered under Option 1, the notice must be sent to Delta Dental (see page 11 for address). If you are covered under Option 2, the notice must be sent to DeltaCare USA (see page 23 for address).

If you are not already enrolled, for questions about KPIC’s Dental Insurance Plan, contact Delta Dental at:

800‑933‑9312 Monday through Friday, 8 a.m. — 4 p.m. Pacific time

Your Kaiser Federal plan ID number is #09874

If you are already enrolled in the KPIC Dental Insurance Plan, for more information, contact Delta Dental at:

800‑835‑2244 Monday through Friday, 8 a.m. — 8 p.m. Pacific time


For questions about DeltaCare USA, contact Delta Dental at:

800‑422‑4234 Monday through Friday 8 a.m. — 8 p.m. Pacific time


You have two dental plans to choose from:

1KPIC’s Dental PPO Insurance Plan allows you the freedom to see any licensed dentist of your choice. It uses a Table of Allowances that lists the dollar amount KPIC will pay for each covered dental service. A copy of the Table of Allowances is included in this brochure. You must be enrolled in Kaiser Permanente’s traditional HMO medical plan to elect this dental coverage.

With KPIC’s Dental PPO Insurance Plan . . .• You have the freedom to choose any licensed dentist.• Each family member may visit a different dentist.• Table of Allowances lists the specific dollar amount

payable for each covered dental service.• Your out‑of‑pocket costs will usually be lowest if you

visit a Delta Dental PPOTM Dentist (PPO Dentist). If you can’t find a PPO Dentist, a Delta Dental Premier® Dentist (Premier Dentist) is your next best option. PPO and Premier dentists will not bill you above their Delta Dental contracted fees for covered services.

• Find Delta Dental dentists at deltadentalins.com.• Orthodontic services (braces) are not covered.• Claims are handled for you when you visit one of Delta

Dental’s approximately 47,100 participating dentist locations in California.

• Use your 10‑digit Kaiser Permanente Medical Record Number (MRN) or your social security number as your ID (to use your MRN, include the leading zeros).

• There is an annual deductible of $50 per person ($150 maximum per family); the maximum coverage annually is $1,000 per person.

• There is no deductible for diagnostic and preventive services.

• Some procedures are subject to a waiting period.

See KPIC Dental section beginning on page 2

KPIC Dental Insurance Plan Monthly premium*

Self only $34.69

Self and 1 party $61.48

Self and 2 or more $92.41

* Good through December 31

2DeltaCare USA is a dental HMO program. With DeltaCare USA, you select a conveniently located network dentist to provide dental care for you and your family. A list of participating network dentists is enclosed for your review. Depending on the service you receive, you pay either a set dollar copayment or no copayment at all. With the DeltaCare USA program, there are no deductibles and no claim forms. You must be enrolled in Kaiser Permanente’s traditional HMO medical plan to elect this dental coverage.

With DeltaCare USA . . .• You select one of the more than 6,400 network dentists

statewide.• General dental care for the entire family is provided an

assigned Contract Dentist. Specialty care is coordinated through your Contract Dentist.

• You pay a set or no copayment for covered services.• Orthodontic services (braces) with a copayment of $1,600

for children under 19 and $1,800 for covered adults and dependent adult children.

• There are no claim forms to complete.• There are no deductibles.• There are no annual maximums except for accidental

injury.

See DeltaCare USA section beginning on page 13

DeltaCare USA Monthly* Quarterly*

Self only $14.26 $42.77

Self and 1 party $23.87 $71.60

Self and 2 or more $36.18 $108.53

* Good through December 31

These benefits are neither offered nor guaranteed under contract with the FEHB Program. Remember that you are enrolling in your selected dental plan for a minimum of 12 consecutive months. This does not apply if your employment is terminated. Payment for either the KPIC or DeltaCare USA plan may be automatically withdrawn from the checking, savings or credit union account you specify. To review a brochure of the program, visit kp.org/feds.

1

KPIC Dental

KPIC Dental PPO Insurance Plan

One of your non‑FEHB Dental plan options is a dental PPO insurance plan underwritten by KPIC, and administered by Delta Dental of California.

KPIC’s dental PPO insurance plan uses a Table of Allowances and allows you the freedom to see any licensed dentist of your choice. The Table of Allowances lists the dollar amount KPIC will pay for each covered dental service. A copy of the Table of Allowances is shown on pages 6 and 8 of this brochure.

The monthly premiums for calendar year 2020 are listed below:


Self only $34.69

Self and 1 Party $61.48

Self and 2 or more $92.41

* Good through December 31, 2020

These benefits are neither offered nor guaranteed under contract with the FEHB Program.

Note: This is only a brief description of your coverage. A certificate of insurance and schedule of coverage setting forth the terms and conditions of your coverage will be sent to you after you enroll. The dental coverage described in this section of the brochure is underwritten by Kaiser Permanente Insurance Company, a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP).

About KPIC’s Dental Insurance PlanIf you’re concerned about the cost of dental treatment for you and your family, you should know about KPIC’s dental PPO insurance plan. With a low monthly premium, KPIC’s group dental insurance plan allows you to budget for your annual dental costs. You can do this because KPIC’s dental PPO insurance plan contains a Table of Allowances listing the specific dollar amount KPIC will pay for each covered dental service. Since you receive in advance the complete Table of Allowances for the plan, you’ll know exactly how much of your treatment will be covered. Because dental fees do vary by dentist, it may be to your advantage to compare your dentist’s fees prior to making an appointment.

Who can joinAs a Federal employee or a Federal retiree enrolled in one of Kaiser Permanente’s Plans, you and your eligible dependents are eligible for coverage under KPIC’s dental PPO insurance plan. Your eligible dependents include your lawful spouse and children from birth to age 26, including stepchildren and children placed with you for adoption or foster care. A child 26 years of age or older may continue to be eligible as a dependent if incapable of self‑support due to a mental or physical disability that commenced prior to age 26, provided that the person is chiefly dependent upon the eligible member, due to a mental or physical disability, and Delta Dental receives notice of the disability.

Free choice of dentistsYou may see any dentist for your covered treatment whether the dentist is a PPO Dentist, Premier Dentist or a Non‑Delta Dental Dentist. However, as a PPO plan, the greatest benefits ‑ including out‑of‑pocket savings ‑ occur when you choose a PPO Dentist. You can find Delta Dental dentists at deltadentalins.com. To use KPIC’s dental PPO insurance plan, simply make an appointment with the dentist of your choice. Be sure to give the dental office your Kaiser Federal plan ID number and social security number or Medical Record Number (MRN).

Special advantages from Delta Dental dentistsKPIC’s dental PPO insurance plan is administered by Delta Dental of California, and you get special advantages when you go to one of the more than 47,100 Delta Dental dentist locations in California. These participating dentists have agreed to handle all your claims paperwork and to charge you no more than their Delta Dental contracted fees. As KPIC’s administrator, Delta Dental reimburses these dentists directly, so you are responsible only for the amount of the charge that exceeds the covered amount shown in

2

KPIC Dental

the Table of Allowances and any deductible, non‑covered services and/or amount over the annual maximum. Your out‑of‑pocket costs will usually be lowest if you visit a Delta Dental PPO Dentist. If you can’t find a PPO Dentist, a Delta Dental Premier Dentist is your next best option. PPO and Premier Dentists will not bill you above their Delta Dental contracted fees for covered services (no “balance billing”). You may use your 10‑digit Kaiser Permanente Medical Record Number (MRN) or your social security number as your ID number (to use your MRN, include the leading zeros). Find Delta Dental dentists at deltadentalins.com. If you go to a Non‑Delta Dentist (a dentist not contracted with Delta Dental), you are responsible for the entire charge and must submit a claim to Delta Dental for reimbursement. Delta Dental will reimburse you directly for the amount shown in the Table of Allowances. Since a majority of California’s dentists are Delta Dental dentists, your current dentist is probably already participating. Ask your dentist if he or she is a Delta Dental dentist.

Predictable costsWith KPIC’s dental PPO insurance plan you know exactly how much KPIC will pay for a covered dental service. Just refer to the Table of Allowances on pages 6 to 8 of this brochure to see how much KPIC will pay for each covered dental service.

No deductible on diagnostic and preventive servicesYour calendar year deductible is $50 per person, up to a maximum of $150 for the family. There is no deductible on diagnostic and preventive services. Your benefits cover a maximum of $1,000 of dental services for each covered enrollee per calendar year.

When you enroll in KPIC’s dental PPO insurance plan, you are enrolling for a minimum period of 12 consecutive months. This does not apply if your employment is terminated.

Waiting periodsSome of the covered dental services listed in the Table of Allowances are subject to a waiting period. This is the period of time that you and your covered dependents are required to have been continuously covered under KPIC’s dental PPO insurance plan before a specific dental service will be a covered benefit. Consult the Table of Allowances on pages 6 and 8 of this brochure for the specific dental services that are subject to a waiting period.

BenefitsKPIC’s dental PPO insurance plan covers the following benefits when they are provided by a licensed dentist and when necessary and customary by the standards of generally accepted dental practice:

I. Diagnostic and preventive benefits

Diagnostic• oral examinations• x‑rays• diagnostic casts• biopsy/tissue examinations• specialist consultations

Preventive• prophylaxis treatments (cleanings)• fluoride treatments• space maintainers

Limitations on diagnostic and preventive benefits• Benefits for oral examinations are limited to two

exams in any calendar year while the patient is covered under any KPIC dental insurance plan. See “Additional benefits during pregnancy.”

• Benefits for cleanings or a procedure for cleaning are limited to two in any calendar year while the patient is covered under any KPIC dental insurance plan. See “Additional benefits during pregnancy.” Routine cleanings are covered as diagnostic and preventive and periodontal cleanings are covered as a basic benefit.

• Fluoride treatments are limited to two in any calendar year while the patient is covered under any KPIC dental insurance plan.

• Full mouth x‑rays are covered only after five years have elapsed following any prior provision of full mouth x‑rays under any KPIC dental insurance plan. Bitewing x‑rays are covered on request by the dentist, but not more than twice in a calendar year for children through 18, and once in a calendar year for adults, while the patient is an eligible person under any KPIC dental insurance plan.

• Panoramic x‑rays are provided as an individual service only after five years have elapsed since any prior panoramic x‑ray was provided under any KPIC dental insurance plan.

• Additional benefits during pregnancy: If you are pregnant, KPIC will pay for additional services to help improve your oral health during pregnancy. The additional services each calendar year while you are eligible in this KPIC dental insurance plan include: one additional oral examination and either one additional routine cleaning or one additional periodontal scaling and root planing per quadrant. Written confirmation of your pregnancy must be provided by you or your dentist when the claim is submitted.

3

KPIC Dental

II. Basic benefits

Oral surgery• extractions and certain other surgical procedures,

including pre‑ and post‑operative care

Restorative • amalgam, synthetic porcelain and plastic restorations

(fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay)

Endodontics• treatment of the tooth pulp (root canal treatment)

Periodontics • treatment of gums and bones supporting the teeth

Sealants• protective coating for posterior molar teeth

Emergency• palliative treatment

Limitations on basic benefits• Periodontal scaling and root planing is a benefit

once for each quadrant each 24‑month period. See “Additional benefits during pregnancy.”

• Basic restorative benefits are subject to a six‑month waiting period.

• Sealants are available for first molars for eligible persons through age 8 and for second molars for eligible persons through age 15. The benefit includes the application of sealants only to permanent first and second molars with no caries (decay), with no restorations and with the occlusal surface intact. The sealants benefit does not include the repair or replacement of a sealant on any tooth within two years of its application.

III. Crowns, inlays, onlays and cast restoration benefits• crowns, inlays, onlays and cast restorations will

be covered when teeth cannot be restored with amalgam, synthetic porcelain or plastic restorations

Limitations on crowns, inlays, onlays and cast restoration benefits• Crowns, inlays, onlays and cast restoration benefits

are subject to a six‑month waiting period

IV. Prosthodontic benefitsProcedures for construction or repair of fixed bridges, partial or complete dentures

Limitations on prosthodontic benefits• Prosthodontic treatment is subject to a six‑month

waiting period. See Table of Allowances for further reference.

• Prosthodontic appliances that were provided under any KPIC program will be replaced only after five (5) years have passed, except when KPIC determines that there is such extensive loss of remaining teeth or change in supporting tissue that the existing fixed bridge or denture cannot be made satisfactory. Fixed prosthodontic appliances are limited to Enrollees age 16 and older. Replacement of a prosthodontic appliance not provided under a KPIC program will be made if KPIC determines it is unsatisfactory and cannot be made satisfactory.

• KPIC dental PPO insurance plan will pay the listed allowance toward the dentist’s fee for a standard cast chrome or acrylic partial denture or a standard complete denture. (A “standard” complete or partial denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth and which is constructed using accepted and conventional procedures and materials.)

• KPIC will not pay for implants (artificial teeth implanted into or on bone or gums), their removal or other associated procedures, but KPIC will credit the cost of a crown, pontic or standard complete or partial denture toward the cost of the implant associated appliance i.e., the implant supported crown or denture. The implant appliance is not covered.

V. General limitations — optional services• If an eligible person selects a more expensive plan of

treatment than is customarily provided, or specialized techniques rather than standard procedures, KPIC will pay the listed allowance for the lesser procedure, and the patient is responsible for the remainder of the dentist’s fee (examples: a crown where a silver filling would restore the tooth or a precision denture where a standard denture would suffice).

VI. General exclusions• Treatment of injuries covered by Workers’

Compensation or Employer’s Liability Laws.

• Services which are provided to the Covered Person by any Federal or State Governmental Agency or are provided without cost to the Covered Person by any municipality, county or other political subdivision, unless this exclusion is prohibited by law.

• Services for congenital (hereditary) or developmental (following birth) malformations, including but not limited to cleft palate, upper and lower jaw malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth) and anodontia (congenitally missing teeth), except those services provided to newborn children

4

KPIC Dental

for medically diagnosed congenital defects or birth abnormalities.

• Treatment to stabilize teeth, treatment to restore tooth structure lost from wear (abrasion, erosion), or treatment to rebuild or maintain chewing surfaces due to teeth out of alignment or occlusion. Examples include but are not limited to: equilibration, periodontal splinting, occlusal adjustments or occlusal guards and abfraction.

• Any Single Procedure, provided prior to the date the Enrollee became eligible for services under this program.

• Prescribed drugs, medication, pain killers, antimicrobial agents, or experimental/investigational procedures.

• Experimental procedures.

• Charges by any hospital or other surgical or treatment facility and any additional fees charged by the Provider for treatment in any such facility.

• Charges for anesthesia, except for general anesthesia administered by a licensed Provider in connection with covered oral surgery procedures.

• Extraoral grafts (grafting of tissues from outside the mouth to oral tissues).

• Services for implants (prosthetic appliances placed into or on the bone of the upper or lower jaw to retain or support dental prosthesis) their removal or other associated procedures.

• Services for any disturbance of the temporomandibular (jaw) joints or associated musculature, nerves and other tissues (TMJ).

• Replacement of existing restoration for any purpose other than active tooth decay.

• Intravenous sedation, occlusal guards and complete occlusal adjustment.

• Hypnosis.

• Dental practice administrative services including but not limited to, preparation of claims, any non‑treatment phase of dentistry such as provision of an antiseptic environment, sterilization of equipment or infection control, or any ancillary materials used during the routine course of providing treatment such as cotton swabs, gauze, bibs, masks or relaxation techniques such as music.

• Charges for speech therapy.

• Charges for lost or stolen appliances.

• Services for which no charge is normally made in the absence of insurance.

• Charges incurred for oral hygiene instruction, a plaque control program, preventive control programs including home care times, dietary instruction, x‑ray duplications, cancer screening, tobacco counseling or broken appointments.

• Orthodontic treatment.

• Treatment plans that are more expensive than those customarily provided or specialized techniques used instead of standard procedures; for example, a precision denture where a standard denture would suffice.

• Maxillofacial prosthetics.

• Provisional and/or temporary restorations except an interim removable partial denture is covered only to replace extracted anterior permanent teeth during the healing period.

• Cosmetic surgery or procedures for purely cosmetic reasons.

• Laboratory processed crowns for Enrollees under age 12.

• Fixed bridges and removable partials for Enrollees under age 16.

• Interim implants.

• Indirectly fabricated resin‑based inlays and onlays.

• Treatment by someone other than a Provider or a person who by law may work under a Provider’s direct supervision.

• Services or supplies covered by any other health plan of the Contract holder.

• Procedures having a questionable prognosis based on a dental consultant’s professional review of the submitted documentation.

• Any tax imposed (or incurred) by a government, state or other entity, in connection with any fees charged for Benefits provided under the Contract, will be the responsibility of the Enrollee and not a covered benefit.

• Deductibles, amounts over plan maximums and/or any service not covered under the dental plan.

• Services covered under the dental plan but exceed Benefit limitations or are not in accordance with processing policies in effect at the time the claim is processed.

• Procedures not shown on the Table of Allowances.

To determine how much your out‑of‑pocket costs will be and what services will be covered, ask your dentist to obtain a pre‑treatment estimate from Delta Dental.

5

KPIC Dental

KPIC Dental Insurance Plan 2020 Table of AllowancesThe amounts in the Allowance column shown below are what KPIC will pay for covered services subject to the limitations and exclusions of the plan.

Enrollees are responsible for paying the remainder of the Accepted Fee, the amount the attending Dentist agrees to accept as payment in full for services

rendered. Please refer to your Certificate of Insurance for further clarification of benefits. Enrollees should discuss all treatment options with their Dentist

prior to services being rendered.

Text that appears in brackets { } below is specifically intended to clarify the delivery of benefits under the Delta Dental program and is not to be

interpreted as CDT 2020 procedure codes, descriptors or nomenclature that are under copyright by the American Dental Association. The American

Dental Association may periodically change CDT codes or definitions. Such updated codes, descriptors and nomenclature may be used to describe these

covered procedures in compliance with federal legislation.

Code Description

D0100 – D0999 DiagnosticClinical oral evaluations

Allowance

D0120 Periodic oral evaluation — established patientD0140 Limited oral evaluation — problem focusedD0145 Oral evaluation for a patient under 3 years of age and counseling

with primary caregiverD0150 Comprehensive oral evaluation — new or established patientD0160 Detailed and extensive oral evaluation — problem focused, by

reportD0170 Re‑evaluation — limited, problem focused (established patient;

not post‑operative visit)D0180 Comprehensive periodontal evaluation — new or established

patient

Pre‑diagnostic services

$18.00$25.20$18.00

$25.20$21.00

$21.00

$21.00

D0190 Screening of a patientD0191 Assessment of a patient

Diagnostic imaging

$12.60$12.60

D0210 Intraoral — complete series of radiographic imagesD0220 Intraoral — periapical first radiographic imageD0230 Intraoral — periapical each additional radiographic imageD0240 Intraoral — occlusal radiographic imageD0250 Extra‑oral — 2D projection radiographic image created using a

stationary radiation source, and detectorD0270 Bitewing — 1 radiographic imageD0272 Bitewings — 2 radiographic imagesD0273 Bitewings — 3 radiographic imagesD0274 Bitewings — 4 radiographic imagesD0277 Vertical bitewings — 7 to 8 radiographic imagesD0290 Posterior‑anterior or lateral skull and facial bone survey

radiographic imageD0330 Panoramic radiographic image

Oral pathology laboratory

$45.00$12.00$5.00

$12.00$19.00

$11.00$17.00

$20.50$24.00$45.00$19.00

$37.00

D0419 Assessment of salivary flow by measurementD0472 Accession of tissue, gross examination, preparation and

transmission of written reportD0473 Accession of tissue, gross and microscopic examination,

preparation and transmission written reportD0474 Accession of tissue, gross and microscopic examination,

including assessment of surgical margins for presence of disease, preparation and transmission of written report

Risk assessment

$3.00$59.00

$59.00

$59.00

D0601 Caries risk assessment and documentation, with a finding of low risk

D0602 Caries risk assessment and documentation, with a finding of moderate risk

D0603 Caries risk assessment and documentation, with a finding of high risk

D1000 – D1999 PreventiveDental prophylaxis

$3.00

$3.00

$3.00

D1110 Prophylaxis — adultD1120 Prophylaxis {child through age 13}

Topical fluoride treatment (office procedure)

$43.20$33.60

D1206 Topical application of fluoride varnishD1208 Topical application of fluoride — excluding varnish

Other preventive services

$10.80$10.80

D1351 Sealant — per toothD1352 Preventive resin restoration in a moderate to high caries risk

patient — permanent toothSpace maintenance (passive appliances)

$20.00$24.00

D1510D1515D1520D1525

Space maintainer — fixed — unilateralSpace maintainer — fixed — bilateralSpace maintainer — removable — unilateralSpace maintainer — removable — bilateral

$115.00$191.00$143.00$187.00

Code DescriptionD1556 Removal of fixed unilateral space maintainer – per quadrantD1557 Removal of fixed unilateral space maintainer ‑ maxillaryD1558 Removal of fixed unilateral space maintainer ‑ mandibular

D2000 – D2999 Restorative{Restorative procedures are subject to a 6 month waiting period}Amalgam restorations (including polishing)

Allowance$23.00$23.00$23.00

D2140 Amalgam — 1 surface, primary or permanentD2150 Amalgam — 2 surfaces, primary or permanentD2160 Amalgam — 3 surfaces, primary or permanentD2161 Amalgam — 4 or more surfaces, primary or permanent

Resin‑based composite restorations‑direct

$35.00$43.00$52.00$58.00

D2330 Resin‑based composite — 1 surface, anteriorD2331 Resin‑based composite — 2 surfaces, anteriorD2332 Resin‑based composite — 3 surfaces, anteriorD2335 Resin‑based composite — 4 or more surfaces or involving

incisal angle (anterior)D2390 Resin‑based composite crown, anteriorD2391 Resin‑based composite — 1 surface, posteriorD2392 Resin‑based composite — 2 surfaces, posteriorD2393 Resin‑based composite — 3 surfaces, posteriorD2394 Resin‑based composite — 4 or more surfaces posterior

Inlay/onlay restorations

$46.00$46.00$46.00$68.00

$114.00$47.00$64.00$80.00$80.00

D2510 Inlay — metallic — 1 surfaceD2520 Inlay — metallic — 2 surfacesD2530 Inlay — metallic — 3 or more surfacesD2542 Onlay — metallic — 2 surfacesD2543 Onlay — metallic — 3 surfacesD2544 Onlay — metallic — 4 or more surfacesD2650 Inlay — resin‑based composite — 1 surfaceD2651 Inlay — resin‑based composite — 2 surfacesD2652 Inlay — resin‑based composite — 3 or more surfacesD2662 Onlay — resin‑based composite — 2 surfacesD2663 Onlay — resin‑based composite — 3 surfacesD2664 Onlay — resin‑based composite — 4 surfaces

Crowns — single restoration only

$99.00$133.00$150.00$191.00$191.00$191.00$34.00$50.00$63.00$50.00$63.00$63.00

D2710 Crown — resin‑based composite (indirect)D2712 Crown — ¾ resin‑based composite (indirect)D2720 Crown — Resin with high noble metalD2721 Crown — resin with predominantly base metalD2722 Crown — resin with noble metalD2740 Crown — porcelain/ceramic substrateD2750 Crown — porcelain fused to high noble metalD2751 Crown — porcelain fused to predominantly base metalD2752 Crown — porcelain fused to noble metalD2753 Crown ‑porcelain fused to titanium or titanium alloy5

D2780 Crown — ¾ cast high noble metalD2781 Crown — ¾ cast predominantly base metalD2782 Crown — ¾ cast noble metalD2790 Crown — full cast high noble metalD2791 Crown — full cast predominantly base metalD2792 Crown — full cast noble metalD2794 Crown — titanium and titanium alloy

Other restorative services

$80.00$80.00$182.00$163.00$177.00$192.00$182.00$163.00$177.00$186.00$186.00$186.00$186.00$183.00$170.00$178.00$183.00

D2910

D2915

D2920D2921D2929D2930

Recement or re‑bond inlay, onlay, veneer or partial coverage restorationsRecement or re‑bond indirectly fabricated or prefabricated post and coreRecement or re‑bond crownReattachment of tooth fragment, incisal edge or cuspPrefabricated porcelain/ceramic crown — primary toothPrefabricated stainless steel crown — primary tooth

$27.00

$27.00

$27.00$51.00

$90.00$65.00

The above CDT codes and nomenclature are copyright of the American Dental Association. Note: Some nomenclature has been abbreviated. This appendix represents codes and nomenclature excerpted from the version of Current Dental Terminology (CDT) in effect on the date that this Contract or amendment was issued. CDT coding and nomenclature are the copyright of the American Dental Association, and have been accepted as the standard for data transmission purposes under federal Administrative Simplification regulations. For the purposes of this Appendix, Delta Dental’s administration of Benefits, Limitations and Exclusions under this Contract will at all times be based on the current version of CDT whether or not a revised Appendix B is provided. Notes in brackets { } have been added by Delta Dental for clarification.

6

KPIC Dental

Code DescriptionD2931 Prefabricated stainless steel crown — permanent tooth

D2932 Prefabricated resin crownD2933 Prefabricated stainless steel crown with resin windowD2934 Prefabricated esthetic coated stainless steel crown — primary

toothD2950 Core buildup, including any pins when requiredD2951 Pin retention — per tooth, in addition to restorationD2952 Post and core in addition to crown, indirectly fabricatedD2954 Prefabricated post and core in addition to crownD2960 Labial veneer (resin laminate) — chairsideD2961 Labial veneer (resin laminate) — laboratoryD2962 Labial veneer (porcelain laminate) — laboratoryD2980 Crown repair necessitated by restorative material failureD2981 Inlay repair necessitated by restorative material failureD2982 Onlay repair necessitated by restorative material failureD2983 Veneer repair necessitated by restorative material failure

D3000 – D3999 Endodontics{Endodontic procedures are subject to a 6 month waiting period}Pulpotomy

Allowance$74.00

$80.00$90.00$90.00

$43.00$20.00$92.00$75.00$116.00$128.00$161.00$25.00$25.00$25.00$25.00

D3220 Therapeutic pulpotomy (excluding final restoration) — removal of pulp coronal to the dentinocemental junction and application of medicament

D3221 Pulpal debridement, primary or permanent teethD3222 Partial pulpotomy for apexogenesis — permanent tooth with

incomplete root development

Endodontic therapy on primary teeth

$38.00

$41.00$38.00

D3230 Pulpal therapy (resorbable filling) — anterior, primary tooth (excluding final restoration)

D3240 Pulpal therapy (resorbable filling) — posterior, primary tooth (excluding final restoration)

Endodontic therapy (including treatment plan, clinical procedures and fcare)

$38.00

$38.00

ollow‑up

D3310 Endodontic therapy, anterior tooth (excluding final restoration)D3320 Endodontic therapy, bicuspid tooth (excluding final

restoration)D3330 Endodontic therapy, molar tooth (excluding final restoration)D3333 Internal root repair of perforation defects

Endodontic retreatment

$193.00$227.00

$306.00$56.00

D3346 Retreatment of previous root canal therapy — anteriorD3347 Retreatment of previous root canal therapy — bicuspidD3348 Retreatment of previous root canal therapy — molar

Apexification/recalcification procedures

$193.00$227.00$306.00

D3351 Apexification/recalcification — initial visit (apical closure/calcific repair of perforations, root resorption etc.)

D3352 Apexification/recalcification — interim medication replacement (apical closure/calcific repair of perforations, root resorption, pulpal space disinfection, etc.)

D3353 Apexification/recalcification — final visit (includes completed root canal therapy — apical closure/calcific repair of perforations, root resorption, etc)

Apicoectomy/periradicular services

$56.00

$56.00

$56.00

D3410 Apicoectomy — anteriorD3421 Apicoectomy — bicuspid (first root)D3425 Apicoectomy — molar (first root)D3426 Apicoectomy (each additional root)D3427 Periradicular surgery without apicoectomyD3430 Retrograde filling — per rootD3450 Root amputation — per root

Other endodontic procedures

$240.00$257.00$294.00

$50.00$57.00$57.00

$166.00

D3920 Hemisection (including any root removal), not including root canal therapy

D4000 – D4999 Periodontics{Periodontic procedures are subject to a 6 month waiting period}Surgical services (including usual postoperative services)

$121.00

D4210

D4211

D4212

D4240

D4241

D4245D4249

Gingivectomy or gingivoplasty — 4 or more contiguous teeth or bounded teeth spaces per quadrantGingivectomy or gingivoplasty — 1 to 3 contiguous teeth or bounded teeth spaces per quadrantGingivectomy or gingivoplasty to allow access for restorative procedure, per toothGingival flap procedure, including root planing — 4 or more contiguous teeth or bounded teeth spaces per quadrantGingival flap procedure, including root planing — 1 to 3 contiguous teeth or bounded teeth spaces per quadrantApically positioned flapClinical crown lengthening — hard tissue

$128.00

$77.00

$77.00

$159.00

$95.00

$159.00$96.00

Code Description AllowanceD4260 Osseous surgery (including elevation of a full thickness flap

and closure) — 4 or more contiguous teeth or tooth bounded spaces per quadrant

D4261 Osseous surgery (including elevation of a full thickness flap and closure) — 1 to 3 contiguous teeth or tooth bounded spaces per quadrant

D4264 Bone replacement graft — each additional site in quadrantD4266 Guided tissue regeneration — resorbable barrier, per siteD4267 Guided tissue regeneration — nonresorbable barrier, per site

(includes membrane removal)D4268 Surgical revision procedure, per toothD4270 Pedicle soft tissue graft procedureD4273 Autogenous connective tissue graft procedure (including

donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft

D4277 Free soft tissue graft procedure (including recipient and donor surgical sites), first tooth, implant, or edentulous tooth position in graft

D4278 Free soft tissue graft procedure (including recipient and donor surgical sites), each additional contiguous tooth, implant, or edentulous tooth position in same graft site

Non‑surgical periodontal services

$342.00

$205.00

$47.00$135.00$135.00

$135.00$192.00$233.00

$208.00

$156.00

D4341 Periodontal scaling and root planing — 4 or more teeth per quadrant

D4342 Periodontal scaling and root planing — 1 to 3 teeth per quadrant

D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis

Other periodontal services

$59.00

$35.00

$36.00

D4910 Periodontal maintenanceD4920 Unscheduled dressing change (by someone other than

treating dentist or their staff)

D5000 – D5899 Prosthodontics, removable{Prosthodontic removable procedures are subject to a 12 month waiting Complete dentures (including routine post‑delivery care)

$41.00$36.00

period}

D5110 Complete denture — maxillaryD5120 Complete denture — mandibularD5130 Immediate denture — maxillaryD5140 Immediate denture — mandibular

Partial dentures (including routine post‑delivery care)

$240.00$241.00

$240.00$241.00

D5211 Maxillary partial denture — resin base (including any conventional clasps, rests and teeth)

D5212 Mandibular partial denture — resin base (including any conventional clasps, rests and teeth)

D5213 Maxillary partial denture — cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth

D5214 Mandibular partial denture — cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth)

D5225 Maxillary partial denture — flexible base (including any clasps, rests and teeth)

D5226 Mandibular partial denture — flexible base (including any clasps, rests and teeth)

D5281 Removable unilateral partial denture — 1 piece cast metal (including clasps and teeth)

Adjustments to dentures

$203.00

$212.00

$287.00

$287.00

$216.00

$216.00

$120.00

D5410 Adjust complete denture — maxillaryD5411 Adjust complete denture — mandibularD5421 Adjust partial denture — maxillaryD5422 Adjust partial denture — mandibular

Repairs to complete dentures

$13.00$13.00$14.00$14.00

D5511 Repair broken complete denture base mandibularD5512 Repair broken complete denture base mandibular

D5520 Replace missing or broken teeth — complete denture (each tooth)

Repairs to partial dentures

$31.00$31.00

$25.00

D5611D5612D5621D5622D5630D5640D5650D5660

Repair resin partial denture base, mandibularRepair resin partial denture base, maxillaryRepair cast partial framework, mandibularRepair cast partial framework, maxillaryRepair or replace broken clasp — per toothReplace broken teeth — per toothAdd tooth to existing partial dentureAdd clasp to existing partial denture — per tooth

$30.00$30.00$25.00$25.00$36.00$27.00$31.00$37.00


7

KPIC Dental

Code Description AllowanceDenture rebase proceduresD5710 Rebase complete maxillary dentureD5711 Rebase complete mandibular dentureD5720 Rebase maxillary partial dentureD5721 Rebase mandibular partial denture

Denture reline procedures

$94.00$93.00$89.00$91.00

D5730 Reline complete maxillary denture (chairside)D5731 Reline complete mandibular denture (chairside) D5740 Reline maxillary partial denture (chairside)D5741 Reline mandibular partial denture (chairside)D5750 Reline complete maxillary denture (laboratory)D5751 Reline complete mandibular denture (laboratory)D5760 Reline maxillary partial denture (laboratory)D5761 Reline mandibular partial denture (laboratory)

Interim prosthesis

$46.00$45.00$45.00$47.00$70.00$70.00$71.00$71.00

D5820 Interim partial denture (maxillary)D5821 Interim partial denture (mandibular)

Other removable prosthetic services

$85.00$85.00

D5850 Tissue conditioning — maxillaryD5851 Tissue conditioning — mandibularD5863 Overdenture — complete maxillaryD5864 Overdenture — partial maxillaryD5865 Overdenture — complete mandibularD5866 Overdenture — partial mandibular

D6200 – D6999 Prosthodontics, fixedEach retainer and each pontic constitutes a unit in a fixed partial denture {Fixed prosthodontic procedures are subject to a 6 month waiting period}Fixed partial denture pontics

$25.00$24.00

$240.00$287.00$241.00$287.00

D6210 Pontic — cast high noble metalD6211 Pontic — cast predominantly base metalD6212 Pontic — cast noble metalD6214 Pontic — titaniumD6240 Pontic — porcelain fused to high noble metalD6241 Pontic — porcelain fused to predominantly base metalD6242 Pontic — porcelain fused to noble metalD6243 Pontic – porcelain fused to titanium or titanium alloysD6250 Pontic — resin with high noble metalD6251 Pontic — resin with predominantly base metalD6252 Pontic — resin with noble metal

Fixed partial denture retainers — inlays/onlays

$171.00$138.00$168.00$171.00$176.00$155.00$170.00$170.00$176.00$155.00$170.00

D6545 Retainer — cast metal for resin bonded fixed prosthesisD6549 Resin retainer — for resin bonded fixed prosthesisD6602 Retainer inlay — cast high metal, 2 surfacesD6603 Retainer inlay — cast high metal, 3 or more surfacesD6604 Retainer inlay — cast predominantly base metal, 2 surfacesD6605 Retainer inlay — cast predominantly base metal, 3 or more

surfacesD6606 Retainer inlay — cast noble metal, 2 surfacesD6607 Retainer inlay — cast noble metal, 3 or more surfacesD6610 Retainer onlay — cast high noble metal, 2 surfacesD6611 Retainer onlay — cast high noble metal, 3 or more surfacesD6612 Retainer onlay — cast predominantly base metal, 2 surfacesD6613 Retainer onlay — cast predominantly base metal, 3 or more

surfacesD6614 Retainer onlay — cast noble metal, 2 surfacesD6615 Retainer onlay — cast noble metal, 3 or more surfacesD6624 Retainer inlay — titaniumD6634 Retainer onlay — titanium

Fixed partial denture retainers — crowns

$88.00$88.00$121.00$135.00$121.00$135.00

$121.00$135.00$288.00$288.00$288.00$288.00

$288.00$288.00$135.00$288.00

D6720 D6721 D6722 D6750 D6751 D6752D6753D6780D6781D6782D6784D6790D6791D6792

Retainer crown — resin with high noble metalRetainer crown — resin with predominantly base metalRetainer crown — resin with noble metalRetainer crown — porcelain fused to high noble metalRetainer crown — porcelain fused to predominantly base metalRetainer crown — porcelain fused to noble metalRetainer crown – porcelain fused to titanium or titanium alloysRetainer crown — ¾ cast high noble metalRetainer crown — ¾ cast predominantly base metalRetainer crown — ¾ cast noble metalRetainer crown ¾ ‑ titanium and titanium alloysRetainer crown — full cast high noble metalRetainer crown — full cast predominantly base metalRetainer crown — full cast noble metal

$180.00$161.00$175.00$181.00$161.00$175.00$181.00$181.00$181.00$181.00$181.00

$180.00$159.00$175.00

Code Description AllowanceD6794 Retainer crown — titaniumD6930 Recement or re‑bond fixed partial dentureD6940 Stress breakerD6980 Fixed partial denture repair necessitated by restorative

material failure

D7000 – D7999 Oral and maxillofacial surgery{The folllowing procedures are subject to a 6 month waiting period}Extractions (includes local anesthesia, suturing, if needed, and routine postoperative care)

$180.00$33.00$38.00$50.00

D7111 Extraction, coronal remnants — deciduous toothD7140 Extraction, erupted tooth or exposed root (elevation and/or

forceps removal)

Surgical extractions (includes local anesthesia, suturing, if needed, and postoperative care)

$20.00$39.00

routine

D7210 Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated

D7220 Removal of impacted tooth — soft tissueD7230 Removal of impacted tooth — partially bonyD7240 Removal of impacted tooth — completely bonyD7250 Surgical removal of residual tooth roots (cutting procedure)

Other surgical procedures

$74.00

$90.00$117.00

$134.00$78.00

D7260 Oroantral fistual closureD7261 Primary closure of a sinus perforationD7270 Tooth reimplantation and/or stabilization of accidentally

evulsed or displaced toothD7272 Tooth transplantation (includes reimplantation from one site to

another and splinting and/or stabilization)D7280 Surgical access of unerupted toothD7285 Incisional biopsy of oral tissue — hard (bone, tooth)

D7286 Incisional biopsy of oral tissue — soft

Alveoloplasty — surgical preparation of ridge for dentures

$225.00$225.00$132.00

$98.00

$176.00$136.00

$108.00

D7310 Alveoloplasty in conjunction with extractions — per quadrantD7311 Alveoloplasty in conjunction with extractions — 1 to 3 teeth or

tooth spaces, per quadrantD7320 Alveoloplasty not in conjunction with extractions — per

quadrantD7321 Alveoloplasty not in conjunction with extractions — 1 to 3 teeth

or tooth spaces, per quadrant

Vestibuloplasty

$59.00$36.00

$96.00

$58.00

D7340 Vestibuloplasty — ridge extension (secondary epithelialization)D7350 Vestibuloplasty — ridge extension (including soft tissue grafts,

muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue)

Surgical excision of intra‑osseous lesions

$82.00$218.00

D7450 Removal of benign odontogenic cyst or tumor — lesion diameter up to 1.25 cm

D7451 Removal of benign odontogenic cyst or tumor — lesion diameter greater than 1.25 cm

Excision of bone tissue

$131.00

$273.00

D7471 Removal of lateral exostosis (maxilla or mandible)D7472 Removal of torus palatinusD7473 Removal of torus mandibularis

Surgical incision

$162.00$162.00$162.00

D7510 Incision and drainage of abscess —

Other repair proceduresintraoral soft tissue $48.00

D7960 Frenulectomy — also known as frenectomy or frenotomy — separate procedure not incidental to another procedure

D7970 Excision of hyperplastic tissue — per archD7971 Excision of pericoronal gingiva

D9000 – D9999 Adjunctive general servicesUnclassified treatment

$115.00

$88.00$43.00

D9110 Palliative (emergency) treatment of dental pain‑minor procedure

Anesthesia

$41.00

D9222 Deep sedation/general anesthesia ‑ first 15 minutesD9223 Deep sedation/general anesthesia — each 15 subsequent

minute increment

Professional visits

$36.00$36.00

D9310

D9430

D9440

Consultation — diagnostic service provided by dentist or physician other than requesting dentist or physicianOffice visit for observation (during regularly scheduled hours) — no other services performedOffice visit — after regularly scheduled hours

$43.00

$24.00

$49.00


8

KPIC Dental

Code Description AllowanceDrugsD9610 Therapeutic parenteral drug, single administration $6.00D9612 Therapeutic parenteral drugs, two or more administrations,

different medications$6.00

Miscellaneous servicesD9930 Treatment of complications (post‑surgical) — unusual

circumstances, by report$19.00

D9951 Occlusal adjustment — limited $32.00D9995 Teledentistry‑synchronous; real‑time encounter No CopayD9996 Teledentistry‑asynchronous; information stored and forwarded

to dentist for subsequent reviewNo Copay

D9997 Dental case management – Patients with special Health Care Needs

No Copay


9

KPIC Dental

How to enroll in KPIC’s Dental Insurance Plan1. Complete the enrollment form on page 11, or you

also have the option to enroll online by visiting dentalinfo.biz/kpic_enrollment.html. If you are already a Kaiser Permanente member, please include a copy of your Kaiser Permanente ID card. If you are not yet a Kaiser Permanente member, please include a copy of your Medical Enrollment Form (Form SF 2809). You must be a Federal member of Kaiser Permanente to enroll.

2. Sign the form to authorize automatic payment from your checking, savings or credit union account. Be sure to enclose a voided blank check or deposit form from this account. Call your bank to obtain the automatic deposit routing number and write the number on the payment authorization form.

3. Return the first month’s payment and enrollment materials by December 21, 2019, to:

KPIC Federal Employee Dental Insurance Plan Wolfpack Insurance Services, Inc. P.O. Box 720 Belmont, CA 94002‑0720

4. If your payment and enrollment materials are received by KPIC’s Administrator by December 21, 2019, your effective date of coverage (including your eligible dependents) will be January 1, 2020.

Monthly rates for calendar year 2020


1 person $34.69

2 persons $61.48

3 or more persons $92.41


Payment of monthly chargesThe dental coverage described in this brochure will not become effective until KPIC or its Administrator receives the initial premium from the eligible Federal Employee. The due date for subsequent premiums is the 10th day of each month. The Insured agrees to pay subsequent premiums no later than 31 days following the premium due date, unless the Insured has given notice requesting termination of dental coverage under the Certificate in accordance with the Termination section of the Certificate. The Insured will be responsible for the payment of the pro rata premium for the time dental coverage under the Certificate was in force during the 31‑day grace period.

BillingTo ensure timely processing of your benefits and claim payments, it is necessary that premiums be paid during the month prior to the coverage month. There are two payment options.

You may choose to have your monthly premiums deducted from your checking, savings or credit union account on the 10th of each month prior to the coverage month (e.g., April dues will be deducted on March 10). Please complete the Automatic Payment Authorization form on page 12 of this brochure.

If you do not have a checking, savings or credit union account, you may submit payments via a personal check, money order, etc. When completing the enrollment form, write DIRECT PAY across the top of page 12, “Automatic Payment Authorization.” You will be sent monthly invoices to submit with your premium payments. Premiums must be paid by the 10th of each month prior to the coverage month.

10

KPIC Dental

Notes

11

KPIC — Enroll — 9793 (rev. 08/19)

KPIC Dental

Enrollment form

Instructions: Please complete this Group Dental Enrollment form and return a signed copy with your first month’s payment by December 21, 2019 to Wolfpack Insurance Services Inc., P.O. Box 720, Belmont, CA 94002‑0720.

Kaiser Permanente Insurance Company Oakland, California

Dental PPO enrollment

Enrollment information: Failure to accurately complete the questions on the enrollment form may delay the effective date of your coverage under the KPIC Dental Insurance Plan.

Enrollment — Coverage not elected below will be assumed refused if not specifically refused.

Yes, I would like to enroll in the Kaiser Permanente Insurance Company (KPIC) Dental PPO Plan for Federal Employees. I understand that enrollment is voluntary. By electing to enroll, I agree to participate in the KPIC Trust (and/or any successor Trust), which holds the KPIC Dental Policy. I understand that to be eligible for the Plan, I must be enrolled along with any of my dependents to be covered, in Kaiser Permanente’s Traditional HMO Plan for Federal Enrollees. I further understand that my continued eligibility, and that of my covered dependents, is contingent on our continued enrollment in Kaiser Permanente’s Traditional HMO Plan for Federal Enrollees. I also understand that some covered dental services are subject to waiting periods. I certify that to the best of my knowledge and belief, any information disclosed on this enrollment form, is accurate and that my answers are correct, true and complete.

No, I do not wish to participate. I understand that I will not be entitled to any benefits under the KPIC Dental Plan and will not be able to enroll until the next annual renewal period. (Coverage not elected will be assumed refused, even if not specifically refused.)

Full name

Social security number or 10‑digit Kaiser Permanente medical record number

Mailing address

City, state, zip

Phone number

Male Female Date of birth

Please list eligible dependents to be covered in addition to yourself:

Spouse Male Female

Child Male Female

Child Male Female

Child Male Female

Child Male Female

Child Male Female

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Signature of enrollee Date

12

James Smith 122 Main St. Anyplace, NY 10000

123

PAY TO THE ORDER OF

DOLLARS

$

ANYPLACE BANKAnyplace, NY 10000

For

ı: 1 2 0 0 0 0 0 0 5 ı: 1 2 3 4 5 6 7 8 9 0 ||. 1 2 3

Date

00‑0000/0000

KPIC Dental

Automatic payment authorization

Banking information: Checking account Savings account Credit union account

Routing transit number (RTN) (The first two numbers of the RTN must be 01 through 12 or 21)

Account number (Verify this number with your bank)

Branch name

Phone number Branch number

Automatic Payment Authorization — Please enclose a voided check or preprinted deposit slip from the account checked.

I (we) hereby authorize Delta Dental/Wolfpack Insurance Services, Inc. to charge the applicable monthly dues for 12 months of dental coverage to my account designated above. I understand that coverage will become and remain effective only if there are sufficient funds at the time of the deduction. I agree to comply with the terms as outlined in the certificate of insurance. This authority is to remain in full force and effect until I notify Delta Dental in writing 30 days prior to termination. (My bank is authorized to make corrections if any should be necessary.)

Date

Date

Signature of enrollee

Signature of spouse

To enroll in the KPIC DENTAL insurance plan, please complete the enrollment form in this brochure (page 11) and enclose the first month’s payment payable to Wolfpack Insurance Services, Inc. Return the enrollment form and the first month’s payment by December 21, 2019 to Wolfpack Insurance Services Inc., P.O. Box 720, Belmont, CA 94002‑0720.

Note: Please enclose a voided check or preprinted deposit slip from the account checked. Staple it in the space below. Use only a check that corresponds to the banking information you have provided.

Payment instructions: Payments are due retroactively to the month you and/or dependents enrolled in the Kaiser Federal Employee Dental Plan plus one month in advance. After payment and application are received, the first automatic payment will occur on the 10th of the following month and each month thereafter.

Routing transitnumber

Accountnumber

Attachvoidedcheck or depositsliphere

13

DeltaCare® USA

DeltaCare® USA

One of your non‑FEHB Dental benefit options, DeltaCare USA, is provided by Delta Dental of California, and administered by Delta Dental Insurance Company.

With DeltaCare USA, you select a conveniently located network dentist to provide dental care for you and your family. You pay a set copayment or, for some services, no copayment. There are no deductibles and no claim forms to worry about.

The dues for calendar year 2020 are listed below:

Type Monthly* Quarterly*

Self only $14.26 $42.77

Self and 1 party $23.87 $71.60

Self and 2 or more $36.18 $108.53


These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all eligible enrollees and family members of this Plan.

Note: This is only a brief summary of the program. A Combined Policy and Disclosure Form stating the terms of your program will be sent to you upon enrollment.

Please read the following information so you will know how to get dental care under the DeltaCare USA program.

About DeltaCare USAThe DeltaCare USA program is an HMO dental plan that focuses on preventing dental problems and assuring the delivery of quality dental care.

Delta Dental of California has contracted with a network of Contract Dentists within the state of California. A listing of these offices is included for you in the back of this brochure, or you may go to deltadentalins.com to search for a conveniently located network dentist. The network of dental offices is composed of established dental practices.

Who can joinAs a Federal member of Kaiser Permanente, you are eligible to join the DeltaCare USA program.

Your eligible dependents include your lawful spouse and dependent children from birth to 26 years old, including stepchildren and children placed with you for adoption or foster care. A child 26 years of age or older may continue to be eligible as a dependent if incapable of self‑support due to a mental or physical disability that commenced prior to age 26, provided that the person is chiefly dependent upon the eligible member, and Delta Dental receives notice of the disability.

Emergency servicesDental emergencies are covered up to a maximum of $100.00 per emergency, per Enrollee, less applicable copayment(s).

No claim formsThe dental location you choose provides all primary dental services. There are no claim forms to complete or percentage of usual charges for you to pay.

No deductiblesWith the DeltaCare USA program, there are no required deductibles to pay, so your benefits begin immediately.

No dollar limit of dental benefitsNo annual maximum, except for accidental injury.

Pre‑existing condition restrictionsPre‑existing conditions are not excluded in the DeltaCare USA program. Exception: work in progress.

Prepaid program saves on dental costsYour out‑of‑pocket savings could be substantial. You know the exact cost prior to treatment, allowing you to predict future dental expenses.

When you enroll in this program, you are enrolling for a minimum of 12 consecutive months. This does not apply if your employment is terminated.

14

DeltaCare® USA

Quality review of dental providersOn‑site audits of participating dental locations ensure that established standards of quality are maintained.

Specialty servicesThe DeltaCare USA program offers services in dental specialty areas. These include periodontics (treatment of diseased gums and bone), endodontics (root canal therapy) and oral surgery procedures. Specialty services must be referred by the assigned Contract Dentist and some procedures may require preauthorization. If an enrollee is assigned to a dental school clinic for specialist services, those services may be provided by a dentist, a dental instructor, a clinician or a dental student under the supervision of a dentist.

The DeltaCare USA program provides benefits for listed dental procedures (subject to the provisions, limitations and exclusions shown in the Combined Policy and Disclosure Form) if care is provided by your assigned Contract Dentist.

When you enroll in DeltaCare USA, you select a participating dental office from the DeltaCare USA Network directory to take care of dental needs for you and your family. After you have enrolled, you will receive an Combined Policy and Disclosure Form booklet that fully describes the benefits of your dental program, a welcome letter and a DeltaCare USA membership card. The welcome letter will have the address and telephone number of your participating network dentist. To receive all necessary dental care covered by the program, simply call your selected dental office to make an appointment.

Remember to always contact your assigned Contract Dentist. With the exception of certain Emergency Dental Services or Urgent Dental Services, treatment received other than from the enrollee’s assigned Contract Dentist or not prior authorized by Delta Dental will not be covered under the DeltaCare USA program.

Limitations of benefits (partial list)• Prophylaxis is limited to two treatments at no cost in any

12 consecutive months; additional treatments are available with a $27 patient copayment.

• Full upper and/or lower dentures are not to exceed one each in any five‑year period.

• Replacement of partial dentures within any five‑year period is not covered unless necessary due to natural tooth loss where the addition or replacement of teeth to the existing partial is not feasible.

• Denture relines are limited to one per denture during any 12 consecutive months.

• Periodontal treatments (root planing/subgingival curettage) are limited to five quadrants during any 12 consecutive months.

• Bitewing x‑rays are limited to not more than one series of four films in any six‑month period.

• Full mouth x‑rays are limited to one set every 24 consecutive months.

• Sealants are limited to noncarious, nonrestored permanent first and second molars through age 15.

Exclusions (partial list)The following services are not covered.

• General anesthesia and the services of a special anesthesiologist.

• Cosmetic dental care.

• Dental conditions arising out of and due to the enrollee’s employment or for which Workers’ Compensation is payable. Services which are provided to the enrollee by state government or agency thereof, or are provided without cost to the enrollee by any municipality, county or other subdivisions.

• Dental services performed in a hospital and related hospital fees.

• Loss or theft of fixed and removable prosthetics (crowns, bridges, full or partial dentures).

• Dental expenses incurred in connection with any dental procedure started after termination of eligibility of coverage.

• Any service that is not specifically listed as a covered procedure.

• Dental expenses incurred in connection with any dental procedure started prior to the enrollee’s eligibility. Example: teeth prepared for crowns, root canals in progress, orthodontics.

• Congenital malformations.

• Dispensing of drugs not normally supplied in a dental office.

• Cases in which, in the professional judgment of the attending dentist, a satisfactory result cannot be obtained or where the prognosis is poor or guarded.

• Dental services received from any dental office other than the assigned dental office unless expressly authorized in writing by Delta Dental or as cited under “Emergency Dental Services.”

• Prophylactic removal of impactions (asymptomatic nonpathological).

• “Consultations” for noncovered services.

• Implant placement or removal, appliances placed on, or services associated with, implants.

Orthodontic limitations and exclusions (partial list)• Orthodontic treatment must be provided by a member of

the orthodontic network.

15

DeltaCare® USA

• Program benefits cover 24 months of usual and customary orthodontic treatment.

• If your coverage is terminated for any reason, and you are receiving any orthodontic treatment at the time, your copayment shall be $2, 300 for dependent children to age 19 (and $2, 500 for covered adults and dependent adult children) and be prorated over the number of months to completion of the treatment. Terms and conditions are arranged between you and the orthodontist.

• A consultation fee may be charged if treatment is not required, or if you elect not to start treatment after a diagnosis and consultation have been completed.

• Pre‑, mid‑ and post‑treatment records (cephalometric x‑rays, tracings, photographs and study models) are excluded.

• Retreatment of orthodontic cases is excluded.

• Lost, stolen or broken appliances are excluded.

• Orthodontic treatment in progress is limited to new DeltaCare USA enrollees who, at the time of their original effective date, are in active treatment started under their previous employer sponsored dental plan, as long as they continue to be eligible under the DeltaCare USA program. Active treatment means tooth movement has begun. Enrollees are responsible for all copayments and fees subject to the provisions of their prior dental plan. Delta Dental is financially responsible only for amounts unpaid by the prior dental plan for qualifying orthodontic cases.

16

DeltaCare® USA

Schedule A Description of Benefits and Copayments

The benefits shown below are performed as deemed appropriate by the assigned Contract Dentist subject to the limitations and exclusions of the

program. Please refer to Schedule B of the Combined Policy and Disclosure Form for further clarification of benefits. Enrollees should discuss all

treatment options with their assigned Contract Dentist prior to services being rendered.

Text that appears in brackets { } below is specifically intended to clarify the delivery of benefits under the DeltaCare USA program and is not to be

interpreted as CDT 2020 procedure codes, descriptors or nomenclature that are under copyright by the American Dental Association. The American

Dental Association may periodically change CDT codes or definitions. Such updated codes, descriptors and nomenclature may be used to describe these

covered procedures in compliance with federal legislation. Procedure Codes, limitations and exclusions with age restrictions listed in Schedule A and

Schedule B are subject to exceptions based on medical necessity.

D0100 – D0999 DiagnosticD0120 Periodic oral evaluation — established patient No costD0140 Limited oral evaluation — problem focused No costD0145 Oral evaluation for a patient under 3 years of age and counseling

with primary caregiverNo cost

D0150 Comprehensive oral evaluation — new or established patient No costD0160 Detailed and extensive oral evaluation — problem focused, by

reportNo cost

D0170 Re‑evaluation — limited, problem focused (established patient; not post‑operative visit)

No cost

D0171 Re‑evaluation — post‑operative office visitD0180 Comprehensive periodontal evaluation — new or established

patientNo cost

D0190 Screening of a patient No costD0191 Assessment of a patient No costD0210 Intraoral — complete series of radiographic images {limited to 1

series every 24 months}No cost

D0220 Intraoral — periapical first radiographic image No costD0230 Intraoral — periapical each additional radiographic image No costD0240 Intraoral — occlusal radiographic image No costD0270 Bitewing — 1 radiographic image No costD0272 Bitewings — 2 radiographic images No costD0273 Bitewings — 3 radiographic images No costD0274 Bitewings — 4 radiographic images {limited to 1 in 6 months} No costD0330 Panoramic radiographic image No costD0419 Assessment of salivary flow by measurement No CostD0460 Pulp vitality tests No costD0470 Diagnostic casts No costD0472 Accession of tissue, gross examination, preparation and

transmission of written reportNo cost

D0473 Accession of tissue, gross and microscopic examination, preparation and transmission written report

No cost

D0474 Accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report

No cost

D0999 Unspecified diagnostic procedure, by report {includes office visit, per visit (in addition to other services)}

$10.00

D1000 – D1999 PreventiveD1110 Prophylaxis cleaning — adult {2 per 12 month period} No costD1110 {Additional cleaning — adult (within the 6 month period)} $27.00D1120 Prophylaxis cleaning — child {2 per 12 month period} No costD1120 {Additional cleaning — child (within the 6 month period)} $27.00D1206 Topical application of fluoride varnish {child to age 19; 2

D1206 or D1208 per 12 month period}No cost

D1208 Topical application of fluoride — excluding varnish {child to age 19; 2 D1206 or D1208 per 12 month period}

No cost

D1330 Oral hygiene instructions No costD1351 Sealant — per tooth {limited to permanent molars through

age 15}No cost

D1352 Preventive resin restoration in a moderate to high caries risk patient — permanent tooth {limited to permanent molars through age 15}

$15.00

D1353 Sealant repair — per tooth {limited to permanent molars through age 15}

$15.00

D1354 Interim caries arresting medicament application {child to age 19; 2 per 12 month period}

No cost

D1510 Space maintainer — fixed — unilateral $65.00D1515 Space maintainer — fixed — bilateral $65.00

Code Description Enrollee pays

D1520 Space maintainer — removable — unilateral $65.00D1525 Space maintainer — removable — bilateral $65.00D1551 Re‑cement or re‑bond bilateral space maintainer ‑ maxillary $20.00D1552 Re‑cement or re‑bond bilateral space maintainer ‑

mandibular$20.00

D1553 Re‑cement or re‑bond unilateral space maintainer – per quadrant

$20.00

D1556 Removal of fixed unilateral space maintainer – per quadrant $20.00D1557 Removal of fixed unilateral space maintainer ‑ maxillary $20.00D1558 Removal of fixed unilateral space maintainer ‑ mandibular $20.00

D2000 – D2999 Restorative{Includes polishing, all adhesives and bonding agents, indirect pulp capping, bases, liners and acid etch procedures}D2140 Amalgam — 1 surface, primary or permanent $27.00D2150 Amalgam — 2 surfaces, primary or permanent $32.00D2160 Amalgam — 3 surfaces, primary or permanent $37.00D2161 Amalgam — 4 or more surfaces, primary or permanent $50.00D2330 Resin‑based composite — 1 surface, anterior $75.00D2331 Resin‑based composite — 2 surfaces, anterior $80.00D2332 Resin‑based composite — 3 surfaces, anterior $80.00D2335 Resin‑based composite — 4 or more surfaces or involving

incisal angle (anterior)$80.00

D2390 Resin‑based composite crown, anterior $60.00D2391 Resin‑based composite — 1 surface, posterior1, 2 OptionalD2392 Resin‑based composite — 2 surfaces, posterior1, 2 OptionalD2393 Resin‑based composite — 3 surfaces, posterior1, 2 OptionalD2394 Resin‑based composite — 4 or more surfaces posterior1, 2 OptionalD2510 Inlay — metallic — 1 surface2, 3 OptionalD2520 Inlay — metallic — 2 surfaces2, 3 OptionalD2530 Inlay — metallic — 3 or more surfaces2, 3 OptionalD2542 Onlay — metallic — 2 surfaces2, 3 OptionalD2543 Onlay — metallic — 3 surfaces2, 3 OptionalD2544 Onlay — metallic — 4 or more surfaces2, 3 OptionalD2610 Inlay — porcelain/ceramic — 1 surface2, 3 OptionalD2620 Inlay — porcelain/ceramic — 2 surfaces2, 3 OptionalD2630 Inlay — porcelain/ceramic — 3 or more surfaces2, 3 OptionalD2642 Onlay — porcelain/ceramic — 2 surfaces2, 3 OptionalD2643 Onlay — porcelain/ceramic — 3 surfaces2, 3 OptionalD2644 Onlay — porcelain/ceramic — 4 or more surfaces2, 3 OptionalD2650 Inlay — resin‑based composite — 1 surface2, 3 OptionalD2651 Inlay — resin‑based composite — 2 surfaces2, 3 OptionalD2652 Inlay — resin‑based composite — 3 or more surfaces2, 3 OptionalD2662 Onlay — resin‑based composite — 2 surfaces2, 3 OptionalD2663 Onlay — resin‑based composite — 3 surfaces2, 3 OptionalD2664 Onlay — resin‑based composite — 4 surfaces2, 3 OptionalD2710 Crown — resin‑based composite (indirect)3, 4 $125.00D2712 Crown — ¾ resin‑based composite (indirect)3, 4 $125.00D2720 Crown — resin with high noble metal3, 4, 5 $180.00D2721 Crown — resin with predominantly base metal3, 4 $180.00D2722 Crown — resin with noble metal3, 4 $180.60D2740 Crown — porcelain/ceramic substrate3, 4 $275.00D2750 Crown — porcelain fused to high noble metal3, 4, 5 $275.00D2751 Crown — porcelain fused to predominantly base metal3, 4 $275.00D2752 Crown — porcelain fused to noble metal3, 4 $275.00D2753 Crown ‑porcelain fused to titanium or titanium alloy $250.00D2780 Crown — ¾ cast high noble metal3, 5 $250.00


Procedures not listed above are not covered; however, may be available at the Contract Dentist’s “filed fees.” “Filed fees” means the Contract Dentist’s fees on file with Delta Dental. Questions regarding these fees should be directed to Delta Dental’s Customer Care at 800‑422‑4234. The above CDT codes and nomenclature are copyright of the American Dental Association. Note: Some nomenclature has been abbreviated. This Schedule A represents codes and nomenclature excerpted from the version of Current Dental Terminology (CDT) in effect on the date that the Policy or Amendment was issued. CDT coding and nomenclature are the copyright of the American Dental Association, and have been accepted as the standard for data transmission purposes under federal Administrative Simplification regulations. For the purposes of this Schedule, Delta Dental’s administration of Benefits, Limitations and Exclusions under this plan will at all times be based on the current version of CDT whether or not a revised Schedule B is provided. Notes in brackets { } type have been added by Delta Dental for clarification.

17

DeltaCare® USA

D2781 Crown — ¾ cast predominantly base metal3 $250.00D2782 Crown — ¾ cast noble metal3 $250.00D2790 Crown — full cast high noble metal3, 5 $250.00D2791 Crown — full cast predominantly base metal3 $250.00D2792 Crown — full cast noble metal3 $250.00D2794 Crown — titanium3, 5 and titanium alloy $275.00D2910 Recement or re‑bond inlay, onlay, veneer or partial coverage

restorations$20.00

D2915 Recement or re‑bond indirectly fabricated or prefabricated post and core

$20.00

D2920 Recement or re‑bond crown $20.00D2921 Reattachment of tooth fragment, incisal edge or cusp

{anterior}$80.00

D2929 Prefabricated porcelain/ceramic crown — primary tooth {anterior primary tooth}

$60.00

D2930 Prefabricated stainless steel crown — primary tooth $60.00D2931 Prefabricated stainless steel crown — permanent tooth $60.00D2932 Prefabricated resin crown — anterior primary tooth $60.00D2933 Prefabricated stainless steel crown with resin window

{anterior primary tooth}$60.00

D2940 Protective restoration $15.00D2941 Interim therapeutic restoration — primary dentition $15.00D2949 Restorative foundation for an indirect restoration $25.00D2950 Core buildup, including any pins when required $25.00D2951 Pin retention — per tooth, in addition to restoration $25.00D2952 Post and core in addition to crown, indirectly fabricated

{includes canal preparation}5$90.00

D2953 Each additional indirectly fabricated post — same tooth {includes canal preparation}5

$90.00

D2954 Prefabricated post and core in addition to crown {base metal post; includes canal preparation}

$50.00

D2957 Each additional prefabricated post — same tooth {base metal post; includes canal preparation}

$50.00

D2980 Crown repair necessitated by restorative material failure $45.00D2981 Inlay repair necessitated by restorative material failure $45.00D2982 Onlay repair necessitated by restorative material failure $45.00D2983 Veneer repair necessitated by restorative material failure $45.00D2990 Resin infiltration of incipient smooth surface lesions {limited

to permanent molars through age 15}$15.00

D3000 – D3999 EndodonticsD3110 Pulp cap — direct (excluding final restoration) $12.00D3120 Pulp cap — indirect (excluding final restoration) $12.00D3220 Therapeutic pulpotomy (excluding final restoration) — removal

of pulp coronal to the dentinocemental junction and application of medicament

$45.00

D3221 Pulpal debridement, primary and permanent teeth $45.00D3222 Partial pulpotomy for apexogenesis— permanent tooth with

incomplete root development$45.00

D3230 Pulpal therapy (resorbable filling) — anterior, primary tooth (excluding final restoration)

$45.00

D3240 Pulpal therapy (resorbable filling) — posterior, primary tooth (excluding final restoration)

$45.00

D3310 {Root canal} — Endodontic therapy, bicuspid tooth (excluding final restoration)6

$150.00

D3320 {Root canal} — Endodontic therapy, bicuspid tooth (excluding final restoration)6

$200.00

D3330 {Root canal} — Endodontic therapy, molar tooth (excluding final restoration)6

$250.00

D3346 Retreatment of previous root canal therapy — anterior6 $200.00D3347 Retreatment of previous root canal therapy — bicuspid6 $250.00D3348 Retreatment of previous root canal therapy — molar6 $300.00D3351 Apexification/recalcification — initial visit (apical closure/calcific

repair of perforations, root resorption etc.)$40.00

D3410 Apicoectomy — anterior6 $200.00D3421 Apicoectomy — bicuspid (first root)6 $200.00D3425 Apicoectomy — molar (first root)6 $200.00D3426 Apicoectomy (each additional root)6 $50.00D3427 Periradicular surgery without apicoectomy $200.00D3430 Retrograde filling — per root6 $50.00D3450 Root amputation — per root {not covered in conjunction with a

hemisection}6$50.00


D4000 – D4999 Periodontics{Includes preoperative and postoperative evaluations and treatment under a local anesthetic}D4210 Gingivectomy or gingivoplasty — 4 or more contiguous

teeth or bounded teeth spaces per quadrant$200.00

D4211 Gingivectomy or gingivoplasty — 1 to 3 contiguous teeth or bounded teeth spaces per quadrant

$50.00

D4212 Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth

$50.00

D4240 Gingival flap procedure, including root planing — 4 or more contiguous teeth or bounded teeth spaces per quadrant

$250.00

D4241 Gingival flap procedure, including root planing — 1 to 3 contiguous teeth or bounded teeth spaces per quadrant

$250.00

D4260 Osseous surgery (including elevation of a full thickness flap and closure) — 4 or more contiguous teeth or tooth bounded spaces per quadrant

$400.00

D4261 Osseous surgery (including elevation of a full thickness flap and closure) — 1 to 3 contiguous teeth or tooth bounded spaces per quadrant

$400.00

D4341 Periodontal scaling and root planing — 4 or more teeth per quadrant {limited to 5 quadrants during any 12 consecutive months}

$50.00

D4342 Periodontal scaling and root planing — 1 to 3 teeth per quadrant — limited to 5 quadrants during any 12 consecutive months

$50.00

D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis {limited to 1 treatment in any 12 consecutive months}

$15.00

D4910 Periodontal maintenance {limited to 2 treatments each 12 month period}

$15.00

D4921 Gingival irrigation — per quadrant No cost

D5000 – D5899 Prosthodontics, removableD5110 Complete denture — maxillary7, 8 $350.00D5120 Complete denture — mandibular7, 8 $350.00D5130 Immediate denture — maxillary7, 8 $450.00D5140 Immediate denture — mandibular7, 8 $450.00D5211 Maxillary partial denture — resin base (including any

conventional clasps, rests and teeth)7, 8$300.00

D5212 Mandibular partial denture — resin base (including any conventional clasps, rests and teeth)7, 8

$300.00

D5213 Maxillary partial denture — cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth)7, 8

$375.00

D5214 Mandibular partial denture — cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth)7, 8

$375.00

D5221 Immediate maxillary partial denture — resin base (including any retentive/clasping materials, rests and teeth)7, 8

$300.00

D5222 Immediate mandibular partial denture — resin base (including any retentive/clasping materials, rests and teeth)7, 8

$300.00

D5223 Immediate maxillary partial denture — cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth)7, 8

$375.00

D5224 Immediate mandibular partial denture — cast metal framework with resin denture bases (including any retentive/clasping materials, rests and teeth)7, 8

$375.00

D5281 Removable unilateral partial denture — 1 piece cast metal (including clasps and teeth)

$150.00

D5410 Adjust complete denture — maxillary7 $20.00D5411 Adjust complete denture — mandibular7 $20.00D5421 Adjust partial denture — maxillary7 $20.00D5422 Adjust partial denture — mandibular7 $20.00D5510 Repair broken complete denture base $45.00D5520 Replace missing or broken teeth — complete denture (each tooth) $15.00D5610 Repair resin denture base $40.00D5620 Repair cast framework $60.00D5630 Repair or replace broken clasp — per tooth $20.00D5640 Replace broken teeth — per tooth $15.00D5650 Add tooth to existing partial denture $15.00D5660 Add clasp to existing partial denture — per tooth $20.00D5710 Rebase complete maxillary denture9 $150.00D5711 Rebase complete mandibular denture9 $150.00D5720 Rebase maxillary partial denture9 $150.00D5721 Rebase mandibular partial denture9 $150.00D5730 Reline complete maxillary denture (chairside)9 $40.00D5731 Reline complete mandibular denture (chairside)9 $40.00



18

DeltaCare® USA

Code

D5740D5741D5750D5751D5760D5761D5820

D5821

D5850D5851

Description Enrollee pays

Reline maxillary partial denture (chairside)9 $40.00Reline mandibular partial denture (chairside)9 $40.00Reline complete maxillary denture (laboratory)9 $150.00Reline complete mandibular denture (laboratory)9 $150.00Reline maxillary partial denture (laboratory)9 $150.00Reline mandibular partial denture (laboratory)9 $150.00Interim partial denture (maxillary) {limited to initial placement $180.00of interim partial denture/stayplate to replace extracted anterior teeth during healing}7

Interim partial denture (mandibular) {limited to initial placement $180.00of interim partial denture/stayplate to replace extracted anterior teeth during healing}7

Tissue conditioning — maxillary7, 9 $30.00Tissue conditioning — mandibular7, 9 $30.00

D5900 – D5999 Maxillofacial prosthetics Not covered

D6000 – D6199 Implant services Not covered

D6200 – D6999 Prosthodontics, fixedEach retainer and each pontic constitutes a unit in a fixed partial denture (bridge)D6210D6211D6212D6240D6241D6242D6245D6250D6251D6252D6545 D6549 D6602D6603D6604D6605

D6606D6607D6610D6611D6612D6613

D6614D6615D6720 D6721 D6722 D6740D6750 D6751

D6752D6753D6780D6781D6782D6784D6790D6791D6792D6930D6940D6980

Pontic — cast high noble metal5, 10

Pontic — cast predominantly base metal10

Pontic — cast noble metal10

Pontic — porcelain fused to high noble metal4, 5, 10

Pontic — porcelain fused to predominantly base metal4, 10

Pontic — porcelain fused to noble metal4, 10

Pontic — porcelain/ceramic2, 10

Pontic — resin with high noble metal4, 5, 10

Pontic — resin with predominantly base metal4, 10

Pontic — resin with noble metal4, 10

Retainer — cast metal for resin bonded fixed prosthesis4, 10

Resin retainer — for resin bonded fixed prosthesisRetainer inlay — cast high metal, 2 surfaces2, 10

Retainer inlay — cast high metal, 3 or more surfaces2, 10

Retainer inlay — cast predominantly base metal, 2 surfaces2, 10

Retainer inlay — cast predominantly base metal, 3 or more surfaces2, 10

Retainer inlay — cast noble metal, 2 surfaces2, 10

Retainer inlay — cast noble metal, 3 or more surfaces2, 10

Retainer onlay — cast high noble metal, 2 surfaces2, 10

Retainer onlay — cast high noble metal, 3 or more surfaces2, 10

Retainer onlay — cast predominantly base metal, 2 surfaces2, 10

Retainer onlay — cast predominantly base metal, 3 or more surfaces2, 10

Retainer onlay — cast noble metal, 2 surfaces2, 10

Retainer onlay — cast noble metal, 3 or more surfaces2, 10

Retainer crown — resin with high noble metal4, 5, 10

Retainer crown — resin with predominantly base metal4, 10

Retainer crown — resin with noble metal4, 10

Retainer crown — porcelain/ceramic2, 10

Retainer crown — porcelain fused to high noble metal4, 5, 10

Retainer crown — porcelain fused to predominantly base metal4, 10

Retainer crown — porcelain fused to noble metal4, 10

Retainer crown – porcelain fused to titanium or titanium alloysRetainer crown — ¾ cast high noble metal5, 10

Retainer crown — ¾ cast predominantly base metal10

Retainer crown — ¾ cast noble metal10

Retainer crown ¾ ‑ titanium and titanium alloysRetainer crown — full cast high noble metal5, 10

Retainer crown — full cast predominantly base metal10

Retainer crown — full cast noble metal10

Recement or re‑bond fixed partial dentureStress breaker10

Fixed partial denture repair necessitated by restorative material failure

$240.00$240.00$240.00$275.00$275.00$275.00Optional$180.00$180.00$180.00$150.00$150.00

OptionalOptionalOptionalOptional

OptionalOptionalOptionalOptionalOptionalOptional

OptionalOptional$180.00$180.00$180.00

Optional$275.00$275.00

$275.00$240.00$240.00$240.00$240.00$240.00$240.00$240.00$240.00

$45.00$60.00$45.00


D7000 – D7999 Oral and maxillofacial surgery{Includes preoperative and postoperative evaluations and treatment under a local anesthetic}D7111 Extraction, coronal remnants — deciduous tooth $35.00D7140 Extraction, erupted tooth or exposed root (elevation and/or $35.00

forceps removal)D7210 Surgical removal of erupted tooth requiring removal of $45.00

bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated

D7220 Removal of impacted tooth — soft tissue $75.00D7230 Removal of impacted tooth — partially bony $100.00D7240 Removal of impacted tooth — completely bony $150.00D7241 Removal of impacted tooth — completely bony, with unusual $150.00

surgical complicationsD7250 Surgical removal of residual tooth roots (cutting procedure) $100.00D7251 Coronectomy — intentional partial tooth removal $150.00D7286 Incisional biopsy of oral tissue — soft {does not include $10.00

histopathologic examination or other pathology laboratory procedures}

D7310 Alveoloplasty in conjunction with extractions — per quadrant $50.00D7311 Alveoloplasty in conjunction with extractions — 1 to 3 teeth or $50.00

tooth spaces, per quadrantD7320 Alveoloplasty not in conjunction with extractions — per quadrant $75.00D7321 Alveoloplasty not in conjunction with extractions — 1 to 3 teeth $75.00

or tooth spaces, per quadrant

D7471 Removal of lateral exostosis (maxilla or mandible) {per site} $50.00D7510 Incision and drainage of abscess — intraoral soft tissue $50.00D7960 Frenulectomy — also known as frenectomy or frenotomy — $25.00

separate procedure not incidental to another procedure

D8000 – D8999 OrthodonticsD8070 Comprehensive orthodontic treatment of the transitional $1,550.00

dentition {child or adolescent to age 19}11

D8080 Comprehensive orthodontic treatment of the adolescent $1,600.00dentition {adolescent to age 19}11

D8090 Comprehensive orthodontic treatment of the adult dentition $1,800.00{adults, including dependent adult children age 19 and older}11

D8660 Pre‑orthodontic treatment examination to monitor growth and No costdevelopment {not to be charged with any other consultation procedure(s)}12

D8680 Orthodontic retention (removal of appliances, construction and No costplacement of retainers)13

D8681 Removable orthodontic retainer adjustment13 No costD8999 Unspecified orthodontic procedure, by report includes the $350.00

START‑UP FEE {which includes initial examination, diagnosis, consultation and initial banding}

D9000 – D9999 Adjunctive general servicesD9110 Palliative (emergency) treatment of dental pain‑minor procedure $35.00D9211 Regional block anesthesia No costD9212 Trigeminal division block anesthesia No costD9215 Local anesthesia in conjunction with operative or surgical No cost

proceduresD9219 Evaluation for deep sedation or general anesthesia No costD9310 Consultation — diagnostic service provided by dentist or No cost

physician other than requesting dentist or physician (specialist only)

D9430 Office visit for observation (during regularly scheduled hours) — No costno other services performed

D9440 Office visit — after regularly scheduled hours $50.00D9932 Cleaning and inspection of removable complete denture, No cost

maxillaryD9933 Cleaning and inspection of removable complete denture, No cost

mandibularD9934 Cleaning and inspection of removable partial denture, maxillary No costD9935 Cleaning and inspection of removable partial denture, No cost

mandibularD9997 Dental case management – Patients with special Health Care No Cost

Needs


19

DeltaCare® USA

Footnotes1. An amalgam is the benefit.2. Optional is defined as any alternative procedure presented by the Contract

Dentist that satisfies the same dental need as a covered procedure, is chosen by the Enrollee, and is subject to the Limitations and Exclusions of the program. The applicable charge to the Enrollee is the difference between the Contract Dentist’s “filed fee” for the Optional procedure and the “filed fee” for the covered procedure, plus any applicable Copayment. “Filed fees” means the Contract Dentist’s fees on file with Delta Dental. Questions about the DeltaCare USA program should be directed to Delta Dental’s Customer Care at 800‑422‑4234.

3. Replacement is limited to restorations that are 5+ years old.4. Porcelain and other tooth‑colored materials on molars are considered a material

upgrade with a maximum additional charge to the Enrollee of $150.00.5. Base or noble metal is the benefit. High noble metal (precious), if used, will be

charged to the Enrollee at the additional maximum cost of $100.00 per tooth. If an indirectly fabricated post and core is made of high noble metal, an additional fee up to $100.00 per tooth will be charged for the upgrade. This charge also applies to a titanium crown.

6. A benefit for permanent teeth only.7. Includes after delivery adjustments and tissue conditioning, if needed, for the first

6 months after placement, if the Enrollee continues to be eligible and the service is provided at the Contract Dentist’s facility where the denture was originally delivered.

8. Replacement limited to dentures that are 5+ years old.9. Limited to 1 per denture during any 12 consecutive months.10. Replacement is limited to bridges that are 5+ years old.11. Listed Copayment covers up to 24 months of active orthodontic treatment

excluding the services listed for D8999 (Start‑up fee). Beyond 24 months of active treatment, an additional monthly fee of $75.00 applies.

12. If comprehensive orthodontic treatment is not required or is declined by the Enrollee, a fee of $25.00 will apply. The Enrollee is also responsible for any incurred orthodontic diagnostic record fees.

13. Includes adjustments and/or office visits up to 24 months. After 24 months, a monthly fee of $75.00 applies.


20

DeltaCare® USA

Schedule B

Limitation of benefits1. Full mouth x‑rays are limited to one set every 24

consecutive months and include any combination of periapicals, bitewings and/or panoramic film.

2. Bitewing x‑rays are limited to not more than one series of four films in any six month period.

3. Diagnostic casts are limited to aid in diagnosis by the Contract Dentist for covered benefits.

4. If a biopsy is preauthorized by Delta Dental for an oral surgeon, then examination of the resulting biopsy specimen is covered under codes D0472, D0473 or D0474 and available at no additional cost.

5. Prophylaxis or periodontal maintenance is limited to two procedures each 12 month period.

6. Benefits for sealants include the application of sealants only to permanent first and second molars with no decay, with no restorations and with the occlusal surface intact, for first molars and second molars through age 15. Benefits for sealants do not include the repair or replacement of a sealant on any tooth within three years of its application.

7. A filling is a benefit for the removal of decay, for minor repairs of tooth structure or to replace a lost filling.

8. A crown is a benefit when there is insufficient tooth structure to support a filling or to replace an existing crown that is non‑functional or non‑restorable and meets the five year limitation (see Limitation #12).

9. A covered metallic inlay, onlay, crown or fixed partial denture (bridge) using base or noble metal is available for listed Copayment(s). If the Enrollee elects to have high noble metal used instead, the maximum additional cost of this material upgrade is $100.00 per tooth or pontic. For an indirectly fabricated post and core, the benefit is for base or noble metal. If the Enrollee elects to have a high noble metal indirectly fabricated post and core instead, the maximum additional cost of this material upgrade is $100.00 per tooth.

10. For molars, a covered crown or unit of a fixed partial denture (bridge) is a full cast metal restoration without porcelain or other tooth‑colored material. If the Enrollee elects to have porcelain, porcelain‑ fused‑to‑metal, resin or resin‑with‑metal used instead, the maximum additional cost for this tooth‑colored material upgrade is $150.00 per molar.

11. If a porcelain margin is also chosen by the Enrollee for a covered porcelain‑fused‑to‑metal crown, the maximum additional cost for this laboratory upgrade is $75.00.

12. The replacement of an existing inlay, onlay, crown, fixed partial denture (bridge) or a removable full or partial denture is covered when:

a. The existing restoration/bridge/denture is no longer functional and cannot be made functional by repair or adjustment, and

b. Either of the following:• The existing non‑functional restoration/bridge/

denture was placed five or more years prior to its replacement, or

• If an existing partial denture is less than five years old, but must be replaced by a new partial denture due to the loss of a natural tooth, which cannot be replaced by adding another tooth to the existing partial denture.

13. A direct or indirect pulp cap is a benefit only on a vital permanent tooth with an open apex or a vital primary tooth.

14. With the exception of pulp caps and pulpotomies, endodontic procedures (e.g. root canal therapy, apicoectomy, retrofill, etc.) are only a benefit on a permanent tooth.

15. A therapeutic pulpotomy on a permanent tooth is limited to palliative treatment when the Contract Dentist is not performing root canal therapy.

16. Periodontal scaling and root planing are limited to five quadrants during any 12 month period.

17. Full mouth debridement (gross scale) is limited to one treatment in any 12 month period.

18. The benefit for the replacement of a missing posterior tooth (or teeth) is a removable partial denture. Coverage for the placement of a fixed partial denture (bridge) is optional except in the following cases:

• The sole tooth to be replaced in the arch is a permanent anterior tooth, provided it is not in connection with a partial denture on the same arch; or

• The new bridge would replace an existing, non‑functional bridge utilizing the same abutment teeth, with no additional abutments or pontics with the exception of posterior cantilever bridges (see Limitation #12); or

• The abutment teeth are not being crowned solely for the purpose of supporting a pontic (each abutment tooth to be crowned must meet Limitation #8).

19. Relines, tissue conditioning and rebases are limited to one per denture during any 12 consecutive months.

20. Interim partial dentures (stayplates), in conjunction with fixed or removable appliances, are limited to:

• The replacement of extracted anterior teeth for adults during a healing period when the teeth cannot be added to an existing partial denture or

21

DeltaCare® USA

• The replacement of permanent tooth/teeth for children under 16 years of age.

21. Retained primary teeth shall be covered as primary teeth.

22. Excision of the frenum is a benefit only when it results in limited mobility of the tongue, it causes a large diastema between teeth or it interferes with a prosthetic appliance.

23. Benefits provided by a pediatric Dentist are limited to children through age seven following an attempt by the assigned Contract Dentist to treat the child and upon prior authorization by Delta Dental, less applicable Copayments. Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis.

24. In cases of accidental injury, benefits available are described in Schedule B, Accident Injury Benefit. Damages to the hard and soft tissues of the oral cavity from normal masticatory (chewing) function, exclusive attrition and normal wear, will be covered as described in Schedules A, Description of Benefits and Copayments; and B, Limitations and Exclusions of Benefits.

25. Benefits for a soft tissue management program are limited to those that are listed covered services on Schedule A. If an Enrollee declines non‑covered services within a soft tissue management program, it does not eliminate or alter the benefit for covered services.

26. A new removable partial, complete or immediate denture includes after delivery adjustments and tissue conditioning at no additional cost for the first six months after placement if the Enrollee continues to be eligible and the service is provided at the Contract Dentist’s facility where the denture was originally delivered.

27. An Optional procedure is defined as any alternative procedure presented by the Contract Dentist that satisfies the same dental need as a covered procedure, is chosen by the Enrollee, and is subject to the limitations and exclusions of the program. The applicable charge to the Enrollee is the difference between the Contract Dentist’s “filed fees” for the Optional procedure and the “filed fees” for the covered procedure, plus any applicable Copayment for the covered procedure. Optional treatment does not apply when alternative choices are benefits. Optional procedures include:

• The use of a tooth‑colored material when restoring a posterior tooth with a filling, inlay or onlay; and

• Units in a fixed partial denture (bridge) made of porcelain/ceramic, which is not fused to and supported by underlying cast metal.

28. Porcelain crowns, porcelain fused to metal or resin with metal type crowns are not a benefit for children under 16 years of age. An allowance will be made for a resin crown. (See Limitation #27).

“Filed fees” means the Contract Dentist’s fees on file with Delta Dental. Questions regarding these fees should be directed to Delta Dental’s Customer Care at 800‑422‑4234.

Exclusions of benefits1. Any procedure that is not specifically listed under

Schedule A, Description of Benefits and Copayments.

2. Dental conditions arising out of and due to Enrollee’s employment for which Workers’ Compensation is paid. Services which are provided to the Enrollee by state government or agency thereof, or are provided without cost to the Enrollee by any municipality, county or other subdivision, except as provided in Section 1373(a) of the California Health and Safety Code.

3. All related fees for admission, use, or stays in a hospital, out‑patient surgery center, extended care facility, or other similar care facility.

4. Loss or theft of full or partial dentures, space maintainers, crowns and fixed partial dentures (bridges).

5. Dental expenses incurred in connection with any dental procedures started after termination of eligibility for coverage.

6. Dental expenses incurred in connection with any dental procedure started before the Enrollee’s eligibility with the DeltaCare USA program. Examples include: teeth prepared for crowns, root canals in progress, orthodontics.

7. Congenital malformations (e.g. congenitally missing teeth, supernumerary teeth, enamel and dentinal dysplasias, etc.), except for the treatment of newborn children with congenital defects or birth abnormalities.

8. Dispensing of drugs not normally utilized in the delivery of dental services.

9. Any procedure that in the professional opinion of the Contract Dentist:

a. Has poor prognosis for a successful result and reasonable longevity based on the condition of the tooth or teeth and/or surrounding structures, or

b. Is inconsistent with generally accepted standards for dentistry.

10. Dental services received from any dental facility other than the assigned Contract Dentist including the services of a dental specialist, unless expressly authorized in writing by Delta Dental or as cited under Emergency Services. To obtain written authorization,

22

DeltaCare® USA

the Enrollee should call Delta Dental’s Customer Care at 800‑422‑4234.

11. Consultations for non‑covered benefits.

12. Implant placement or removal, appliances placed on or services associated with implants, including but not limited to prophylaxis and periodontal treatment.

13. Fixed partial dentures (bridges) for children under 16 years of age.

14. Restorations placed solely due to cosmetics, abrasions, attrition, erosion, restoring or altering vertical dimension, congenital or developmental malformation of teeth.

15. Appliances or restorations necessary to increase vertical dimension, replace or stabilize tooth structure loss by attrition, realignment of teeth, periodontal splinting, gnathologic recordings, equilibration or treatment of disturbances of the temporomandibular joint (TMJ).

16. An initial treatment plan which involves the removal and reestablishment of the occlusal contacts of 10 or more teeth with crowns, onlays, fixed partial dentures (bridges), or any combination of these is considered to be full mouth reconstruction under the DeltaCare USA program. Crowns, onlays and fixed partial dentures associated with such a treatment plan are not covered Benefits. This exclusion does not eliminate the benefit for other covered services.

17. Precious metal for removable appliances, metallic or permanent soft bases for complete dentures, porcelain denture teeth, precision abutments for removable partials or fixed partial dentures (overlays, implants, and appliances associated therewith) and personalization and characterization of complete and partial dentures.

18. Extraction of teeth, when teeth are asymptomatic/non‑pathologic (no signs or symptoms of pathology or infection), including but not limited to the removal of third molars and orthodontic extractions.

19. Treatment or extraction of primary teeth when exfoliation (normal shedding and loss) is imminent.

Orthodontic limitationsThe DeltaCare USA program provides coverage for orthodontic treatment plans provided through Contract Orthodontists. The start‑up fees and the cost to the Enrollee for the treatment plan are listed in Schedule A, Description of Benefits and Copayments and subject to the following:

1. Orthodontic treatment must be provided by a Contract Orthodontist.

2. Benefits cover 24 months of active comprehensive orthodontic treatment. Included is the initial examination, diagnosis, consultation, initial banding, 24 months of active treatment, de‑banding and the

retention phase of treatment. The retention phase includes the initial construction, placement and adjustment to retainers and office visits for a maximum of two years.

3. Treatment plans extending beyond 24 months of active treatment, or 24 months of the retention phase of treatment will be subject to a monthly office visit fee to the Enrollee not to exceed $75.00 per month.

4. Should an Enrollee’s coverage be cancelled or terminated for any reason, and at the time of cancellation or termination be receiving any orthodontic treatment, the Enrollee and not Delta Dental will be responsible for payment of any balance due for treatment provided after cancellation or termination. In such a case the Enrollee’s payment shall be based on a maximum of $2,300.00 for covered dependent children to age 19 and $2,500.00 for covered adults and dependent adult children age 19 and older. The amount will be prorated over the number of months to completion of the treatment and, will be payable by the Enrollee on such terms and conditions as are arranged between the Enrollee and the Contract Orthodontist.

5. If treatment is not required or the Enrollee chooses not to start treatment after the diagnosis and consultation has been completed by the Contract Orthodontist, the Enrollee will be charged a consultation fee of $25.00 in addition to diagnostic record fees.

6. Three recementations or replacements of a bracket/band on the same tooth or a total of five rebracketings/rebandings on different teeth during the covered course of treatment are benefits. If any additional recementations or replacements of brackets/bands are performed, the Enrollee is responsible for the cost at the Contract Orthodontist’s “filed fees.”

7. Comprehensive orthodontic treatment (Phase II) consists of repositioning all or nearly all of the permanent teeth in an effort to make the Enrollee’s occlusion as ideal as possible. This treatment usually requires complete fixed appliances; however, when the Contract Orthodontist deems it suitable, a European or removable appliance therapy may be substituted at the same Copayment amounts as for fixed appliances.

8. Orthodontic treatment in progress is limited to new DeltaCare USA Enrollees who, at the time of their original effective date, are in active treatment started under their previous employer sponsored dental plan, as long as they continue to be eligible under the DeltaCare USA program. Active treatment means tooth movement has begun. Enrollees are responsible for all Copayments and fees subject to the provisions of their prior dental plan. Delta Dental is financially responsible only for amounts unpaid by the prior dental plan for qualifying orthodontic cases.

23

DeltaCare® USA

“Filed fees” means the Contract Orthodontist’s fees on file with Delta Dental. Questions regarding these fees should be directed to Delta Dental’s Customer Care at 800‑422‑4234.

Orthodontic exclusions1. Pre‑, mid‑ and post‑treatment records which include

cephalometric x‑rays, tracings, photographs and study models.

2. Lost, stolen or broken orthodontic appliances.

3. Retreatment of orthodontic cases.

4. Changes in treatment necessitated by accident of any kind, and/or lack of Enrollee cooperation.

5. Surgical procedures incidental to orthodontic treatment.

6. Myofunctional therapy.

7. Surgical procedures related to cleft palate, micrognathia or macrognathia.

8. Treatment related to temporomandibular joint disturbances.

9. Supplemental appliances not routinely used in typical comprehensive orthodontics.

10. Restorative work caused by orthodontic treatment.

11. Phase I orthodontics, as well as activator appliances and minor treatment for tooth guidance and/or arch expansion. Phase I orthodontics is defined as early treatment including interceptive orthodontia prior to the development of late mixed dentition.

12. Extractions solely for the purpose of orthodontics.

13. Transfer after banding has been initiated.

14. Composite bands, lingual adaptation of orthodontic bands and other specialized or cosmetic alternatives to standard fixed and removable orthodontic appliances.

Accident injury benefitsAn accidental injury is damage to the hard and soft tissue of the mouth caused directly and independently of all other causes by external forces. Damage to the hard and soft tissue of the mouth from normal chewing function is covered under Schedule A, Description of Benefits and Copayments.

Delta Dental will pay up to 100 percent of the Contract Dentist’s “filed fees, ” for expenses an Enrollee incurs for an accident injury, less any applicable Copayment(s), up to a Maximum of $1,600.00 in any 12 month period.

Accident injury benefits include the following procedure in addition to those listed in Schedule A, Description of Benefits and Copayments:

Code D7270 — Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth and/or alveolus — includes splinting and/or stabilization.

Payment of accident injury benefits is subject to Schedule B, Limitations and Exclusions of Benefits, in addition to the following provisions:

Maximum Accident injury benefits will be provided for each Enrollee up to a maximum of $1,600.00 in any 12 month period.

Limitation Accident injury benefits are limited to services provided as a result of an accident which occurred (a) while the Enrollee was covered under the DeltaCare USA program, or (b) while the Enrollee was covered under another DeltaCare USA program, and if the benefits for the expenses incurred would have been paid if the Enrollee had remained covered under that program.

Exclusions In addition to Schedule B, limitations #13, #15, #20, #21, #24 and #28 and exclusions #1‑9, #11‑15, #18 and #19, the following exclusions apply:

1. Prophylaxis.

2. Extra‑oral grafts (grafting of tissues from outside the mouth to oral tissue).

3. Replacement of existing restorations due to decay.

4. Orthodontic services (treatment of malalignment of teeth and/or jaws).

5. Replacement of existing restorations, crowns, bridges, dentures and other dental or orthodontic appliances damaged by accident injury.

“Filed fees” means the Contract Dentist’s fees on file with Delta Dental. Questions regarding these fees should be directed to Delta Dental’s Customer Care at 800‑422‑4234.

How to enroll in DeltaCare USAComplete the enrollment form on pages 25 and 26. If you are already a Kaiser Permanente member, please include a copy of your Kaiser Permanente ID card. If you are not yet a Kaiser Permanente member, please include a copy of your Medical Enrollment Form (Form SF 2809). You must be a Federal member of Kaiser Permanente to enroll.

Please select one of the following payment methods on the attached enrollment form. The two payment methods are explained below.

Monthly payment via automatic deduction1. Complete and sign the Automatic Payment

Authorization section on the enrollment form. Be sure to enclose a voided blank check from this account.

24

DeltaCare® USA

Also, please call your bank to obtain the ABA number (bank routing number).

2. Your Monthly Dues will be deducted from the account specified on the 15th of each month prior to the coverage month (e.g., April dues will be deducted on March 15th). Your coverage will automatically be terminated if your automatic deduction is declined by your bank for insufficient funds, a closed account, etc.

3. Return the enrollment materials by December 21, 2019 if you are enrolling during the open enrollment period to:

Delta Dental of California c/o Delta Dental Insurance Company P.O. Box 660138 Dallas, TX 75266‑0138

Quarterly payment via check1. Submit the first quarterly payment with your enrollment

form. Once enrolled, you will be billed quarterly (i.e., every three months) thereafter. Dues must be paid in full by the 15th of the month prior to the coverage month or your coverage will be automatically terminated. You cannot have a break in coverage.

2. Return the enrollment form and the first quarterly payment (see quarterly rates on the enrollment form) by December 21, 2019 if you are enrolling during the open enrollment period to:

Delta Dental of California, c/o Delta Dental Insurance Company P.O. Box 660138 Dallas, TX 75266‑0138

Note: If you are a new Federal employee or enrolling outside of the open enrollment period, the enrollment information must be received at the latest by the 15th of the month for coverage to begin the 1st of the following month. Incomplete/inaccurate information will cause a delay in your enrollment into the program.

25

DeltaCare® USA

Notes

26

DeltaCare® USA

Enrollment form

Delta Dental of California c/o Delta Dental Insurance Company P.O. Box 660138 Dallas, TX 75266‑0138

Kaiser Permanente Federal Member dental program enrollment

DeltaCare USA

This is a dental HMO program. You and your family must receive all treatment from the DeltaCare USA dental office you select. Please indicate the number of the DeltaCare USA office you have chosen:

#

If you do not select an office, we will select one for you.

Please print

Full name

Social security number or 10‑digit Kaiser Permanente medical record number

Mailing address

City, state, zip

Phone number

Male Female Date of birth Marital status: Single Married

Rates for calendar year 2020

Type Monthlyautomatic deduction

Quarterly payment by check

1 person $14.26 $42.77

2 persons $23.87 $71.60

3 or more persons $36.18 $108.53

Type of enrollment: 1 person 2 persons Three or more persons

Please list eligible dependents to be covered in addition to yourself:

Spouse Male Female

Child Male Female

Child Male Female

Child Male Female

Child Male Female

Child Male Female

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

Date of birth

27

Automatic Payment Authorization

(rev. 08/16)

DeltaCare® USA

Payment

Payment option: Monthly (automatic) Quarterly (payment by check)

I (we) hereby authorize Delta Dental to charge the applicable monthly dues for dental coverage to my account designated below. I understand that coverage will only become and remain effective if there are sufficient funds at the time of the deduction. I understand eligibility begins the first of the month following my initial deduction. This authority to deduct funds from my account is to remain in full force and effect until I notify Delta Dental in writing 30 Days prior to termination. I also understand there cannot be any lapse of coverage in a 12‑month period from the time of my enrollment. I agree to comply with the terms as outlined in the Combined Policy and Disclosure Form. (My bank is authorized to make corrections if any should be necessary.)

Banking information: Checking account Savings account(Please enclose a voided check or preprinted deposit slip from the account checked.)

Routing transit number (RTN) (The first two numbers of the RTN must be 01 through 12 or 21)

Account number (Verify this number with your bank)

Bank or savings and loan name

Branch name

City, state, zip

Branch phone number

Date

Date

Signature of enrollee

Signature of spouse

In accordance with the disclosure requirements of California Health & Safety Code Section 1363(h), this is to advise you that Delta Dental of California’s ratio of health care expense to premiums received for the last calendar year, with respect to the DeltaCare USA Individual Program, was [70.6]%.

Note: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information may be guilty of a felony of the third degree.

James Smith 122 Main St. Anyplace, NY 10000

123

PAY TO THE ORDER OF

DOLLARS

$

ANYPLACE BANKAnyplace, NY 10000

For

ı: 1 2 0 0 0 0 0 0 5 ı: 1 2 3 4 5 6 7 8 9 0 ||. 1 2 3

Routing transitnumber

Accountnumber

Date

00‑0000/0000

Attachvoidedcheck or depositsliphere

28

DeltaCare® USA

DeltaCare USA Participating Dental Offices/ Consultorios dentales de la red DeltaCare USA — California

Please indicate the number of the office you have selected on the DeltaCare USA enrollment form.

Additional dental offices will be added as required. If any office is closed

to further enrollment, Delta Dental reserves the right to assign you

another dental office as close to your home as possible. All members of

your family must be treated at the same facility.

Language assistance: Language capabilities are self‑reported by the

individual dental facilities and not independently verified by Delta Dental.

If an enrollee requires language assistance to enable communication in a

dental setting, Delta Dental will arrange for professional services through

a certified interpretation vendor at no cost to the enrollee.

Atención en otros idiomas: Las habilidades en idiomas son informadas

por las instalaciones dentales individuales y no son verificadas

independientemente por Delta Dental. Si un afiliado requiere ayuda en

otro idioma para poder comunicarse durante la cita dental, Delta Dental

coordinará los servicios profesionales mediante un proveedor certificado

de interpretación sin costo para el afiliado.

Code Language Code Language Code Language Code Language Code Language Code Language

AF Afrikaans CL Creole GR Greek IN Indonesian 14 Mien SM Samoan

AM Armenian HR Croatian HE Hebrew IT Italian PE Persian SP Spanish/Español

AR Arabic CS Czech HI Hindi JA Japanese PL Polish TA Tagalog

KM Cambodian EI East Indian 4 Hmong KO Korean PT Portuguese TH Thai

CA Cantonese FR French HU Hungarian LO Lao RO Romanian TR Turkish

CH Chinese GE German 13 Ilacano 12 Mandarin RU Russian VI Vietnamese

Code Description Code Description

FT Number of full‑time dentists PT Number of part‑time dentists

Code Description

Indicates functional accessibility for individuals with limited mobility. Information regarding dental office accessibility for patients with mobility impairments is available by calling Customer Care at 800‑422‑4234.

Please call 800‑422‑4234 for updates to this list or check the DeltaCare USA Network online Dentist Directory at: deltadentalins.com.

Northern California offices (open)AlamoDC048222ALAMO SMILES DENTAL GROUP3000 Danville Blvd Ste A, 94507‑1572925‑820‑26888/0

AlbanyDC164401 SHADAN JABALI DDS1113 Garfield Ave, 94706‑1212510‑525‑61001/0 (SP)

AntelopeDC016236 WALEGRA DENTAL GROUP8008 Walerga Rd Ste 100, 95843‑9003916‑725‑45304/1 (HI SP)

AntiochDC019985 EAST BAY DENTAL5157 Lone Tree Way, 94531‑8689925‑777‑17194/1

DC036321 WESTERN DENTAL SERVICES2590 Sycamore Dr, 94509‑2909925‑776‑114036/19 (SP)

DC041082WESTERN DENTAL SERVICES4518 Lone Tree Way, 94531‑7414925‑5‑830035/11 (SP)

DC049760 BAY VIEW DENTAL2225 Buchanan Rd Ste G, 94509‑4209925‑237‑37381/0 (CH 12 SP TA TA)

AuburnDC025710 SIERRA FAMILY DENTAL1300 Lincoln Way Ste D, 95603‑5051530‑885‑19311/0 (TA)

DC029835SIERRA SMILES DENTAL GROUP2503 Bell Rd, 95603‑2533530‑823‑38039/0 (SP)

BelmontDC045495 MARIA LOURDES YEO DDS2130 Ralston Ave Ste 1D, 94002‑1664650‑591‑47041/0

DC061179Belmont Plaza Dental Care390 El Camino Real Ste D, 94002‑2006650‑631‑28933/0 (SP)

BerkeleyDC036288 WESTERN DENTAL SERVICES115 Berkeley Sq, 94704‑1206510‑540‑840039/20 (SP)

DC037063 REFRESH DENTAL3031 Telegraph Ave Ste 136, 94705‑2052510‑845‑22401/0 (CA 12 SP)

BrentwoodDC041585 BRENTWOOD SMILES DENTAL GROUP6660 Lone Tree Way Ste 7, 94513‑5310925‑513‑836310/1 (SP)

BurlingameDC011568MASHA MEKHTEYS DDS1860 El Camino Real Ste 315, 94010‑3114650‑692‑05551/0

Cameron ParkDC053964 Country Club Dental3222 Royal Dr Ste A, 95682‑8556530‑677‑44573/0

CampbellDC040128BRITE DENTAL281 E Hamilton Ave Ste 2, 95008‑0232408‑871‑97341/0 (SP)

DC061579Signature Dental Practice2505 S Bascom Ave, 95008‑4302408‑377‑89101/0 (SP)

CarmichaelDC043852MODERN DENTAL HEALTH5723 Marconi Ave Ste A, 95608‑4475916‑489‑99901/1 (FR HI KO RU SP)

DC058923Fonda Webber DDS Inc8329 Fair Oaks Blvd Ste D, 95608‑1949916‑571‑27811/0

29

DeltaCare® USA

DC063244 Western Dental Services Inc7141 Fair Oaks Blvd, 95608‑6408916‑488‑97008/0

Castro ValleyDC046614 CASTRO VALLEY SMILES DENTISTRY3779 E Castro Valley Blvd, 94552‑4835510‑581‑05008/0

ChicoDC005531SMILE MAKERS2647 Forest Ave, 95928‑4384530‑879‑18880/1 (CA 12 TA)

DC007289LAKEVIEW DENTAL OFFICE2571 California Park Dr Ste 120, 95928‑4042530‑345‑68881/0 (12)

DC036359WESTERN DENTAL SERVICES2471 Cohasset Rd Ste 170, 95926‑1336530‑894‑904029/6 (SP)

DC041931CHICO DENTAL GROUP955 East Ave, 95926‑1308530‑893‑53341/0 (SP TA TA)

DC063325 Western Dental Services Inc1010 Mangrove Ave Ste A B, 95926‑3550530‑342‑75003/0

Citrus HeightsDC011118CITRUS DENTAL GROUP5925 Birdcage Centre Ln Ste D105, 95610916‑246‑15026/1 (SP)

DC137501CITRUS HEIGHTS DENTAL OFFICE6994 Sunrise Blvd, 95610‑3144916‑723‑89003/0 (CH HI HU RO RU SP TA)

ClearlakeDC002986LAKESHORE DENTAL PRACTICE15322 Lakeshore Dr Ste 104, 95422‑9815707‑994‑60500/0

ClovisDC036316 WESTERN DENTAL SERVICES751 W Shaw Ave, 93612‑3217559‑323‑550030/6 (SP)

DC051123CLOVIS CROSSING DENTAL GROUP1095 Herndon Ave Ste 102, 93612‑0504559‑326‑52728/0 (SP)

DC062514 Golden Valley Smiles1010 Shaw Ave Ste B, 93612‑3950559‑323‑17767/0 (GE HI RU SP)

ConcordDC022752CONCORD DENTAL ARTS2222 East St Ste 270, 94520‑2066925‑689‑35000/1

DC030033WILLOW PASS DENTAL CARE1255 Willow Pass Rd, 94520‑5218925‑680‑44441/0 (SP VI)

DC036323WESTERN DENTAL SERVICES1821 Concord Ave, 94520‑2348925‑825‑890034/17 (SP)

DC050448DOWNTOWN CONCORD DENTAL2151 Salvio St Ste A1, 94520‑6305925‑566‑87381/0 (SP)

DC058899Galvan Dental Corporation4375 Clayton Rd Ste D, 94521‑2867925‑676‑63631/0 (SP TA)

DC062463Golden State Smiles1851 Sutter St, 94520‑2559925‑827‑27988/0

Daly CityDC026261 BELLA LIM DDS7455 El Camino Real Ste C, 94014‑2977650‑994‑45611/0 (SP TA)

DC045497MARIA LOURDES YEO DDS2055 Gellert Blvd Ste 4, 94015‑2814650‑754‑13002/0 (TA)

DC136201MOUHANNAD AL‑MAJDALANI DDS320 Washington St Apt 105, 94015‑1972650‑994‑11111/0 (AR KO SP TA)

DC142601RODOLFO VILLASIN DMD341 Westlake Ctr Ste 237, 94015‑1446650‑756‑62111/0 (TA TA)

DanvilleDC043944KAI MING CAI DDS INC4018 Blackhawk Plaza Cir, 94506‑4654925‑736‑98600/1 (CA CH 12 SP)

DC052988Ivory Smiles185 Front St Ste 105, 94526‑3323925‑588‑44441/0 (HI)

DC062029Galvan Dental Care917 San Ramon Valley Blvd Ste 290, 94526‑4032925‑837‑91721/0 (12 SP TA)

DavisDC015572TWIN PINES DENTAL1109 Kennedy Pl Ste 4, 95616‑1271530‑753‑99001/0 (GR SP)

DC048144DAVIS SMILES DENTISTRY DENTAL GROUP4515 Fermi Pl Ste 106, 95618‑9410530‑750‑19557/0 (SP)

DublinDC050466FALLON DENTAL GROUP3746 Fallon Rd, 94568‑7400925‑803‑01005/0 (HI)

DC063465Pannu Dental Group7137 Dublin Blvd Ste A, 94568‑2120925‑828‑67392/0 (CH HI SP TA)

East Palo AltoDC035084RAVENSWOOD FAMILY DENTISTRY1807 Bay Rd, 94303‑1312650‑289‑77005/0 (HI SP VI)

El CerritoDC036291 WESTERN DENTAL SERVICES11299 San Pablo Ave Ste A, 94530‑2166510‑231‑014736/18 (SP)

DC052788 Firoozeh Lavassani411 Kearney St, 94530‑3656510‑527‑17421/0 (AR TA)

DC061473Dentists of El Cerrito Plaza Dental170 El Cerrito Plz, 94530‑4002925‑294‑06654/0 (SP)

DC085001RODNEY KIM DDS11100 San Pablo Ave Ste 107, 94530‑2172510‑233‑90221/0 (SP VI)

El Dorado HillsDC023580YOUNES JONAH TABRIZI DDS DENTAL CORP993 Governor Dr Ste 104, 95762‑4290916‑941‑15151/0 (GE)

DC056563TOWN CENTER DENTAL4355 Town Center Blvd Ste 211, 95762‑7115916‑939‑67772/0 (HI RU SP)

El Dorado HlsDC020322GREEN VLY DENTAL GRP & ORTHODONTICS2205 Francisco Dr Ste 150, 95762‑3943916‑934‑02074/1 (12 SP)

Elk GroveDC022838ELK GROVE DENTAL GROUP9640 Bruceville Rd Ste 101, 95757‑5937916‑686‑90303/3 (HI SP)

DC038208DESIGN DENTAL5700 Whitelock Pkwy Ste 120, 95757‑5925916‑714‑33441/1 (HI PT SP)

DC038827CASE DENTAL GROUP9381 E Stockton Blvd Ste 116, 95624‑5069916‑683‑20001/1 (SP)

DC043019LIBERTY FAMILY DENTAL9401 E Stockton Blvd Ste 215, 95624‑5051916‑686‑96270/1 (CH)

DC044629LAGUNA STAR FAMILY DENTAL5105 Laguna Blvd Ste 4, 95758‑5260916‑478‑02221/0 (HI SP)

DC055278Family Smile Center9381 E Stockton Blvd Ste 120, 95624‑5069916‑686‑42121/0 (KO)

30

DeltaCare® USA

DC060194Prestige Dental8450 Elk Grove Blvd Ste 300, 95758‑5964916‑478‑03431/0 (SP)

DC063844 Laguna Park Dentistry4827 Laguna Park Dr Ste 1, 95758‑5159916‑376‑71061/0 (PE SP VI)

Fair OaksDC007282RIVER CITY DENTAL GROUP8908 Madison Ave Ste A, 95628‑4019916‑536‑51514/2 (SP)

DC061791Madison Oaks Dental6600 Mercy Ct Ste 200, 95628‑3198916‑966‑60601/0 (HI)

FairfieldDC021421DR RICHARD RAMOS DMD INC3075 Travis Blvd, 94534‑3442707‑435‑90042/0 (SP TA TA)

DC036317 WESTERN DENTAL SERVICES2440 N Texas St, 94533‑1602707‑422‑460042/21 (HI SP)

DC048576FAIRFIELD DENTISTS DENTAL GROUP3332 N Texas St 5C, 94533‑9758707‑399‑90827/0 (SP)

DC058727Galvan Dental Corporation1500 Oliver Rd Ste F, 94534‑3473707‑434‑87771/0 (SP TA)

DC062408VALLE SMILES1955 W Texas St Ste 12, 94533‑4462707‑428‑54005/0 (GE HE HI RU SP)

DC063322 Western Dental Services Inc1600 Travis Blvd, 94533‑3429707‑429‑400011/0

DC137401JULIUS MOSLEY II DDS1261 Travis Blvd Ste 300, 94533‑4800707‑421‑21611/0 (CH SP VI)

FolsomDC036292 WESTERN DENTAL SERVICES1016 Riley St Ste 1, 95630‑3265916‑984‑412745/18

DC040940FOLSOM HILLS DENTISTRY DENTAL GROUP2465 Iron Point Rd Ste 120, 95630‑8754916‑984‑96005/2 (SP)

DC050579RENAISSANCE FAMILY AND COSMETIC DENTISTRY2180 E Bidwell St Ste 100, 95630‑6468916‑983‑98001/0 (HI)

DC063019BSC Dental Smiles2700 E Bidwell St Ste 300, 95630‑6434916‑299‑94871/0

Foster CityDC013159 JING‑JING QIAN DDS1289 E Hillsdale Blvd Ste 3, 94404‑1219650‑572‑85181/0 (CH 12)

FowlerDC063135 United Health Centers of the San Joaquin Valley106 E Main St, 93625‑2433559‑834‑39732/0 (SP)

FremontDC003718 FREMONT HILLS DENTAL OFFICE698 Mowry Ave, 94536‑4113510‑608‑60971/0 (TA TA)

DC010706ROSALIE S GERONIMO DMD INC1956 Driscoll Rd, 94539‑4400510‑440‑14061/0 (TA TA)

DC021389STAR DENTAL5021 Mowry Ave, 94538‑1054510‑797‑49001/0 (HI SP)

DC028713 AMERICAN DENTAL GROUP39624 Mission Blvd, 94539‑3000510‑573‑47432/0 (CA CH 12)

DC033018SHINE DENTAL39055 Hastings St Ste 203, 94538‑1599510‑791‑31441/0 (HI SP)

DC038174GENTLE DENTAL39340 Fremont Blvd, 94538‑1320510‑651‑77005/0 (SP)

DC044899FREMONT DENTAL EXCELLENCE1895 Mowry Ave Ste 120, 94538‑1736510‑494‑81811/0 (GE SP)

DC046655WESTERN DENTAL SERVICES INC3055 Mowry Ave, 94538‑1613510‑494‑903054/0 (SP)

DC055350Brookevale Family Dentistry39236 Argonaut Way, 94538‑1306510‑739‑07011/0 (SP)

DC059356Fremont Randhawa Dental3805 Beacon Ave Ste B, 94538‑1464510‑796‑16001/0 (HI SP)

DC061680Western Dental Services Inc36416 Fremont Blvd, 94536‑7436510‑739‑388916/0 (SP)

DC1C3701DENTAL CARE CENTER39470 Fremont Blvd, 94538‑2117510‑745‑92221/0 (12 SP)

DC228101HILLVIEW DENTAL GROUP40739 Grimmer Blvd, 94538‑2800510‑651‑14402/0 (PT)

FresnoDC014155SAM AKANDE DDS1902 E Ashlan Ave, 93726‑2021559‑228‑30000/1 (SP)

DC026525BULLARD DENTAL GROUP323 E Bullard Ave Ste 104, 93710‑8620559‑439‑99901/0 (AR SP)

DC036301WESTERN DENTAL SERVICES4195 E Shields Ave, 93726‑7025559‑243‑896036/7 (SP)

DC036319 WESTERN DENTAL SERVICES4901 E Kings Canyon Rd, 93727‑3812559‑456‑178543/3 (AR CH SP)

DC036320WESTERN DENTAL SERVICES1255 W Shields Ave, 93705‑3938559‑227‑400044/6 (SP)

DC036325WESTERN DENTAL SERVICES3077 W Shaw Ave, 93711‑3220559‑244‑550141/7 (SP)

DC042111WOODWARD DENTAL CARE7475 N 1st St Ste 103, 93720‑2849559‑431‑76450/1 (SP VI)

DC052655Fig Garden Dental Group1008 West Shaw Ave Ste 105, 93711559‑227‑00277/0 (SP)

DC054234Market Place Smiles Dentistry Dental Group6623 N Riverside Dr Ste 101, 93722‑9308559‑547‑31207/0 (SP)

DC054240Champlain Dentist Dental Group1193 E Champlain Dr Drive, 93720‑5010559‑433‑64279/0 (SP)

DC056329Erbe Palafox DDS Inc4848 N 1st St Ste 106, 93726‑0526559‑227‑62001/0

DC056381 Hossam El‑Zuhery DDS5646 N Palm Ave Ste 101, 93704559‑431‑66261/0

DC059942Noel T Paredes DDS6167 N Fresno St Ste 103, 93710‑8610559‑824‑95241/0 (TA TA)

DC062203Pearl Dentistry1265 E Shaw Ave Ste 100, 93710‑7803559‑224‑01031/0 (SP)

DC062516 Golden Valley Smiles2745 W Shaw Ave Ste 103, 93711‑3315559‑227‑29008/0 (CA GE HI RU SP)

DC062517Golden Valley Smiles5657 E Kings Canyon Rd Ste 107, 93727‑4653559‑454‑79008/0 (CA GE HI RU SP)

DC063218 Western Dental Services Inc5776 N Blackstone Ave Ste 104, 93710‑5026559‑650‑14574/0 (SP)

31

DeltaCare® USA

DC142101FIRST FAMILY DENTAL6115 N 1st St Ste 102, 93710‑5450559‑229‑82001/0 (AR SP)

DC183701ST GEORGE QUALITY DENTAL1515 W Shaw Ave 101, 93711559‑227‑17001/1 (AR AM RU SP)

GaltDC048648GALT DENTAL GROUP1067 C St Ste 125, 95632‑1759209‑744‑04633/0 (KO SP VI)

GilroyDC047040CITY DENTAL CENTER7671 Monterey St Ste C, 95020‑5215408‑842‑50001/0 (SP)

DC053122 Western Dental Services780 1st St, 95020‑4972408‑337‑362049/0 (SP)

DC057456Accu Dental6955 Camino Arroyo Ste 50, 95020‑7342408‑847‑49382/0 (FR HI PE SP VI)

DC061846Gilroy Plaza Dental6974 Automall Pkwy, 95020‑7135408‑847‑41111/0 (HI SP)

HaywardDC039643WESTERN DENTAL SERVICES123 W Jackson St, 94544‑1809510‑887‑570041/9 (SP)

DC040736GENTLE DENTAL HAYWARD24239 Hesperian Blvd, 94545‑1526510‑786‑25874/0 (SP TA VI)

DC062416 Golden State Smiles22755 Foothill Blvd, 94541‑4207510‑782‑41614/0 (HI)

DC155001DENTAL SOLUTIONS/DR SHTULMAN19682 Hesperian Blvd Ste 101, 94541‑4752510‑782‑99420/1 (RU SP)

HerculesDC046985A NOBLE SMILE500 Alfred Nobel Dr Ste 285, 94547‑1844510‑741‑70411/0

JacksonDC058602Kaur Dental Group12120 Industry Blvd Ste 35, 95642‑9374209‑353‑32751/0 (HI SP)

KermanDC063189 United Health Centers of the San Joaquin Valley517 S Madera Ave, 93630‑1523559‑846‑63305/0 (SP TA)

KingsburgDC046249H S MANN DDS INC1518 Draper St, 93631‑1909559‑897‑41111/0 (SP)

LathropDC060184Plume Dental15366 S Harlan Rd, 95330‑8732209‑645‑00321/0 (HI SP)

LincolnDC015202LINCOLN HILLS FAMILY DENTAL2295 Fieldstone Dr Ste 100, 95648‑8807916‑543‑02220/1 (HI)

DC016173PARKWAY DENTAL GROUP781 Sterling Pkwy, 95648‑7320916‑543‑78805/0 (SP)

DC062365 Bella Vista Dental825 Twelve Bridges Dr Ste 55, 95648‑8813916‑543‑44001/0

LivermoreDC039163SMILE LINE DENTISTRY1046 Murrieta Blvd, 94550‑4111925‑456‑76001/1 (HI SP)

DC043734LIVERMORE SMILES DENTISTRY4375 1st St, 94551‑4912925‑294‑92884/1 (SP)

DC044239MINT DENTAL87 Fenton St Ste 105, 94550‑4183925‑292‑52310/1 (SP VI)

DC057460Western Dental Center2177 Las Positas Ct, 94551‑8872925‑273‑600054/0 (SP)

DC063128 Foothill Dental Care1984 Railroad Ave Ste B, 94550‑3108925‑456‑78001/0 (SP TA)

LivingstonDC061690Suave Dental706 Main St, 95334‑1308209‑535‑99332/0 (AR RU SP)

LodiDC062563Dentists of Lodi Dental Group2610 Reynolds Ranch Pkwy Ste 100, 95240‑6848707‑302‑08052/0 (SP)

DC062955Lodi Family Dentistry525 S Fairmont Ave Ste F, 95240‑3860209‑369‑10512/0 (HI SP)

Los AltosDC0C0401SAMSON FU‑KEUNG LEE DDS763 Altos Oaks Dr Ste 3, 94024‑5400650‑948‑60751/0 (CA CH 12 SP)

Los GatosDC024894LOS GATOS DENTAL CARE555 Knowles Dr Ste 112, 95032‑1542408‑370‑77331/0 (AR FR SP)

DC047160ONE SMILE DENTAL15075 Los Gatos Blvd Ste 100, 95032‑2049408‑356‑20497/0 (SP TA)

DC059614Harsono Dental Corp431 Monterey Ave Ste 6, 95030‑5319408‑354‑17171/0 (IN 12)

MaderaDC036342WESTERN DENTAL SERVICES1100 N Gateway Dr, 93637‑9600559‑661‑512035/5 (SP)

DC054667 SAMS DENTAL OFFICE2413 W Cleveland Ave, 93637‑3610559‑395‑48081/0

DC055448iDental Family Dentistry620 W Yosemite Ave, 93637‑4523559‑673‑77001/0 (SP)

MantecaDC022750STADIUM DENTAL GROUP2288 Daniels St, 95337‑6706209‑456‑561012/1 (SP)

DC036347 WESTERN DENTAL SERVICES1332 E Yosemite Ave, 95336‑5004209‑823‑021944/14 (SP)

DC036831 WESTERN DENTAL SERVICES1160 W Yosemite Ave, 95337‑5239209‑624‑516041/15 (SP)

MariposaDC062196Mact Dental Mariposa5192 Hospital Rd, 95338‑9524209‑966‑05733/0 (SP)

MartinezDC042527ALHAMBRA DENTAL GROUP4040 Alhambra Ave, 94553‑3822925‑313‑97001/0 (AR CH SP TA)

MendotaDC063155 United Health Centers of the San Joaquin Valley121 Barboza St, 93640‑1901559‑655‑50003/0 (HI SP TA)

MercedDC036356WESTERN DENTAL SERVICES1124 W Olive Ave, 95348‑1939209‑383‑500035/2 (SP)

DC063326 Western Dental Services Inc12 W 20th St, 95340‑3903209‑388‑10008/0

MilpitasDC019240NISHA DHARMANI DDS430 E Calaveras Blvd, 95035‑5412408‑263‑97141/0 (SP)

DC048832 YOO J KIM40 N Park Victoria Dr Ste D, 95035‑4600408‑263‑03711/0

DC391301ALEXANDER GALANG DDS830 Hillview Ct Ste 150, 95035‑4561408‑934‑76761/0

32

DeltaCare® USA

ModestoDC037885R MESBAH DDS1101 Standiford Ave Ste D3, 95350‑0981209‑571‑54291/0 (SP)

DC038597WESTERN DENTAL SERVICES1720 Hatch Rd, 95351209‑538‑955038/0 (SP)

DC039645WESTERN DENTAL SERVICES2045 W Briggsmore Ave Ste E, 95350‑3770209‑527‑300034/3 (PE SP)

DC045056 RAYMOND NEPOMULENO DDS INC2020 Coffee Rd Ste B4, 95355‑2407209‑529‑58861/0 (SP)

DC046673 WESTERN DENTAL SERVICES INC1705 Prescott Rd, 95350‑2543209‑572‑604515/0

DC049583 AFSHIN BIDGOL DMD3609 Coffee Rd Ste 6, 95355‑1100209‑526‑06761/0

DC054210 Aesthetic Dental Designs1006 H St, 95354209‑338‑33881/0

DC056239Modesto Modern Dentistry Dental Group2103 McHenry Ave Ste C, 95350209‑435‑95507/0

DC060936Modesto Dental Group3025 McHenry Ave Ste N, 95350‑1449209‑527‑39901/0 (AR RU SP)

DC061682 Western Dental Services Inc2900 Standiford Ave Ste 2, 95350‑6575209‑577‑500814/0 (SP)

DC062721 Modesto Smiles Dentistry Dental Group3601 Pelandale Ave Ste D1, 95356209‑245‑00144/0 (SP)

DC063060Great Smiles Dental3219 McHenry Ave Ste E, 95350‑1457209‑409‑89872/0 (AR HI SP TA TA)

DC063219 Western Dental Services Inc2605 Coffee Rd Ste 200, 95355‑2064209‑521‑01008/0 (SP)

DC063220Western Dental Services Inc1440 E Hatch Rd Ste 102, 95351‑5087209‑531‑200010/0 (SP)

MontereyDC053668Monterey Dental Center656 Munras Ave, 93940‑3108831‑920‑21271/0 (AR SP)

Morgan HillDC020283SOUTH VALLEY DENTAL15870 Monterey St, 95037‑5475408‑778‑66841/0 (SP VI)

Mountain ViewDC060508Apple Dental1040 Grant Rd Ste 103, 94040‑3274650‑336‑13131/0 (HI KO SP TA VI)

NapaDC014096TRANCAS DENTAL GROUP935 Trancas St Ste 4E, 94558‑2945707‑257‑62772/0 (CH 12 RO SP TA)

DC017107SISTER ANN COMMUNITY DENTAL1141 Pear Tree Ln Ste 120, 94558‑6485707‑258‑61287/0 (SP VI)

DC039925WESTERN DENTAL SERVICES1260 Trancas St, 94558‑2910707‑501‑510130/9 (SP)

DC054058 Napa Dental Arts1544 Jefferson St, 94559707‑255‑77111/0

DC062464Smile Country Dental2016 Jefferson St, 94559‑1214707‑603‑495510/0 (HI RU SP)

DC063179 Napa Valley Dental Group2119 Jefferson St, 94559‑1211707‑257‑24001/0 (HI SP)

DC063676OLE HEALTH300 Hartle Court, 94559707‑254‑17752/0 (SP)

NewarkDC031197ALL SMILE DENTAL CENTER37070 Newark Blvd Ste E, 94560‑3798510‑790‑82680/1 (CA CH 12 SP)

DC050190PBS A DENTAL CORPORATION5910 Thornton Ave Ste B, 94560‑3800510‑792‑45251/0 (SP TA)

OaklandDC036287WESTERN DENTAL SERVICES1530 Broadway, 94612‑2002510‑251‑100048/17 (SP TA VI)

DC038288OAKLAND SMILE DENTAL8105 Edgewater Dr Ste 124, 94621‑2019510‑924‑73102/0 (HI PE SP)

DC043497OAKLAND SMILE CENTER300 Frank H Ogawa Plz Ste 100, 94612‑2069925‑393‑50271/0 (CH SP)

DC055353 Elegant Smile Dental Center3301 E 12th St Ste 165, 94601‑2939510‑533‑55002/0 (SP)

DC056412 Western Dental Services Inc3405 International Blvd, 94601‑3035510‑469‑201242/0 (SP)

DC057917 Franklin Dental Care1624 Franklin St Ste 1220, 94612‑2824510‑893‑40411/0 (CA CH 12)

DC062677Uptown Dental Group1708 Franklin St Ste B, 94612‑3408510‑465‑77771/0 (SP)

Orange CoveDC063120United Health Centers of the San Joaquin Valley445 11th St, 93646‑2211559‑626‑40312/0 (SP TA)

Palo AltoDC063695Lora Costa DDS INC824 Bryant St, 94301‑2707650‑327‑17871/0 (RU SP TA VI)

ParlierDC063158 United Health Centers of the San Joaquin Valley650 S Zediker Ave, 93648‑2666559‑646‑35615/0 (SP TA)

PetalumaDC020354SURYA MANGA ACHYUTA DDS1372 N McDowell Blvd Ste B1, 94954‑7101707‑778‑99931/0

DC049283PETALUMA MODERN DENTISTRY401 Kenilworth Dr Ste 960, 94952‑3406707‑789‑96004/0 (SP)

DC052705Design Dental Smiles1456 Professional Dr Ste 401, 94954‑6639707‑763‑32030/0 (AR FR SP)

DC055281 PETALUMA VALLEY DENTAL701 Sonoma Mountain Pkwy Ste E1, 94954‑8519707‑782‑07891/0 (AR SP)

PinoleDC056471 Pinole Modern Dentistry Dental Group1208 Fitzgerald Dr, 94564‑2252510‑210‑89075/0 (SP)

PittsburgDC011404SKY DENTAL2230 Gladstone Dr Ste 100, 94565‑5102925‑432‑24442/0 (CA CH SP TA TA)

DC036289WESTERN DENTAL SERVICES2120 Railroad Rd Suite 105, 94565‑4880925‑439‑477434/24 (SP)

PlacervilleDC053988Missouri Flat Dental Group3967 Missouri Flat Rd Ste 120, 95667‑5250530‑642‑28767/0

Pleasant HillDC037931 PLEASANT HILL SMILES DENTAL GROUP2380 Monument Blvd Ste F, 94523‑3972925‑363‑44554/0 (SP)

33

DeltaCare® USA

DC053909PLEASANT HILL WELLNESS DENTAL30 Golf Club Rd Ste C, 94523‑1569925‑685‑86331/0 (KO)

DC062811Richard Ramos DMD Inc.764 Grayson Rd Ste A, 94523‑2685925‑448‑23452/0 (SP TA TA)

PleasantonDC009032LEIDA P STINE DDS INC1400 Santa Rita Rd Ste I, 94566‑5663925‑828‑99931/0 (AR TA TA)

DC042699BERNAL DENTAL CARE3283 Bernal Ave Ste 108, 94566‑6237925‑249‑92420/1 (CH)

DC043338PLEASANTON RIDGE DENTAL GROUP6766 Bernal Ave Ste 560, 94566‑1218925‑461‑31005/1 (SP)

DC044370 PATTANAYAK DENTAL CORPORATION1400 Santa Rita Rd Ste C, 94566‑5663925‑485‑95951/0 (HI SP)

DC044444MOJAB GENERAL & SPECIALIST DENTAL1439 Cedarwood Ln Ste D, 94566‑6127925‑484‑12021/0 (SP)

DC055774Pleasanton Valley Dental Care5460 Sunol Blvd Ste 5, 94566‑7752925‑600‑00651/0 (HI SP)

DC057461Sunflower Dental1400 Santa Rita Rd Ste D, 94566‑5663925‑398‑84031/0 (HI SP)

DC062453Sharda Patel DMD INC1488 Cedarwood Ln Ste D, 94566‑6125925‑846‑44911/0 (HI)

DC164201BERNAL DENTAL GROUP4466 Black Ave Ste K, 94566‑6130925‑485‑11721/1 (HI SP)

DC2C5101ALISAL DENTAL CARE5933 Coronado Ln Ste 205, 94588‑8599925‑846‑63082/0 (HI SP VI)

PortolaDC063711Portola Dental Clinic480 1st Ave, 96122‑9405530‑832‑66022/0 (SP)

Rancho CordovaDC037990RANCHO CORDOVA DENTAL GROUP10910 Olson Dr Ste 100, 95670‑5663916‑638‑37805/1 (SP)

DC047008PROCARE DENTAL11050 Coloma Rd Ste 17, 95670‑2870916‑635‑98001/0 (HI 4 SP)

DC057833Western Dental Services Inc10321 Folsom Blvd Ste A, 95670‑3518916‑362‑520160/0

DC059892Rancho Cordova Smile Dentistry Dental Group4022 Sunrise Blvd Ste 160, 95742‑6908916‑246‑11084/0 (SP)

ReddingDC046993WESTERN DENTAL SERVICES INC1350 Churn Creek Rd Ste F1, 96003‑4168530‑224‑970033/0

DC063328 Western Dental Services Inc1667 Hilltop Dr Ste E, 96002‑0240530‑223‑55009/0

Redwood CityDC012387 EUGENE ESPIRITU705 Veterans Blvd Ste 1, 94063‑1723650‑298‑88180/1 (SP TA)

DC031062UNITED DENTAL647 Veterans Blvd, 94063650‑367‑43000/1 (SP)

DC031550 BIRCH DENTAL GROUP155 Birch St Ste 5, 94062‑1340650‑366‑05520/1 (CA CH SP)

DC036284 WESTERN DENTAL SERVICES975 Veterans Blvd, 94063‑1714650‑365‑890051/8 (SP TA)

DC039731SIVA CHERUKURI DDS193 Arch St Ste B & C, 94062‑1342650‑369‑46162/0 (HI SP TA VI)

DC059007 Randhawa Dental Practice570 El Camino Real Ste 130, 94063‑1248650‑361‑98800/0

DC059008Randhawa Dental Practice570 El Camino Real Ste 130, 94063‑1248650‑361‑98801/0 (HI SP TA)

RichmondDC050866 BAY DENTAL6200 Huntington Ave, 94804‑5746510‑527‑53001/0 (SP)

DC057185Winning Smile Dental Group12732 San Pablo Ave, 94805‑1303510‑233‑31002/0 (SP)

RiverbankDC063873Riverbank Smiles Dental2119 Patterson Rd Ste 9, 95367‑9639209‑502‑77701/0 (HI SP)

RocklinDC016849HIGHLAND DENTAL GROUP3291 Stanford Ranch Rd Ste 102, 95765‑5577916‑435‑16656/1

DC021692HEALTHY SMILES FAMILY DENTISTRY2160 Sunset Blvd Ste 503, 95765‑4790916‑771‑07571/0 (CA CH)

DC041806SERRENITY DENTAL6661 Stanford Ranch Rd Ste D, 95677‑2675916‑630‑10841/0

DC054236Rocklin Modern Dentistry Dental Group5182 Commons Dr Ste 101, 95677‑3911916‑660‑94872/0

DC056520AGAPE DENTAL5752 Lonetree Blvd, 95765‑3734916‑824‑87111/0 (13 TA)

DC057826Gentle Care Family Dentistry at Stanford Ranch6741 Five Star Blvd Ste A, 95677‑2681916‑435‑28641/0 (TA)

DC059896Rocklin Dental Whispers6011 Stanford Ranch Rd Ste 112, 95765‑4416916‑663‑56751/0 (HI SP)

Rohnert ParkDC053921 Rhonert Park Smiles Dentistry6315 Commerce Blvd, 94928‑2403707‑584‑74014/0

DC061951Rio Dental Practice of Susan Malibiran DMD Inc1331 Medical Center Dr Ste H, 94928‑2900707‑585‑85991/0 (PT SP)

RosamondDC037227ADORA OKAM DDS INC1431 W Rosamond Blvd Ste 12, 93560‑7428661‑256‑25601/0 (SP)

RosevilleDC007284GRANITE BAY SMILES DENTISTRY8630 Sierra College Blvd Ste 110, 95661‑6063916‑783‑02447/0 (SP)

DC010386PLEASANT GROVE DENTAL GROUP10357 Fairway Dr Ste 100, 95678‑3544916‑782‑45005/0 (RU)

DC011889ROCKY RIDGE FAMILY DENTAL1700 Rocky Ridge Dr Ste 100, 95661‑2832916‑782‑60010/1 (AM CH FR PL RU SP TA)

DC016175PAVILIONS DENTAL1259 Pleasant Grove Blvd Ste 100, 95678‑6974916‑782‑20105/1 (RU SP)

DC023652STAR DENTAL2030 Douglas Blvd Ste 37, 95661‑3857916‑773‑62222/1 (RU SP)

34

DeltaCare® USA

DC028281 AESTHETIC DENTISTRY8445 Sierra College Blvd Ste B, 95661‑9425916‑773‑05051/0 (AM RU)

DC036335 WESTERN DENTAL SERVICES9450 Fairway Dr Ste 110, 95678‑3588916‑771‑846445/19

DC042339CONFIDENTAL CARE927 Reserve Dr Ste A, 95678‑1383916‑742‑54242/0

DC049096EUREKA RIDGE DENTISTRY1490 Eureka Rd Ste 130, 95661‑2825916‑409‑39791/0

DC054709 ARIA FAMILY DENTAL4014 Foothills Blvd Ste 103, 95747916‑780‑99901/0

DC055416 TERESA DEGUZMAN DDS CORPORATION2436 Professional Dr Ste 200, 95661‑7779916‑774‑99201/0

DC056525Roseville Star Dental1950 Douglas Blvd Ste B1, 95661‑3827916‑783‑71051/0 (HI SP)

DC059645Mark W Redford DMD Inc8211 Sierra College Blvd Ste 404, 95661‑9405916‑773‑93002/0 (FR)

DC060181Gurkamal Sandhu DDS Inc1895 E Roseville Pkwy Ste 100, 95661‑7977916‑789‑87661/0 (HI)

DC060724Apple Dental9600 Fairway Dr Ste 150, 95678‑3548916‑788‑82521/0 (SP)

DC062778Roseville Family Dental Care3981 Foothills Blvd Ste 160, 95747‑7348916‑773‑43431/0 (HI)

DC063100Esthetic Dentistry and Implants140 Folsom Rd, 95678‑2744916‑784‑21292/0 (RU SP)

SacramentoDC010387PARK PLACE DENTAL GROUP4690 Natomas Blvd Ste 100, 95835‑2230916‑515‑45006/2 (SP)

DC014095SAID SHAARI DDS77 Cadillac Dr Ste 270, 95825‑8338916‑649‑82000/1 (RU SP)

DC016569MARKET WEST DENTAL GROUP3290 Arena Blvd Ste 610, 95834‑3003916‑574‑94007/0 (SP)

DC018046MIRACLE SMILE DEZHAM DENTAL GROUP2131 Capitol Ave Ste 100, 95816‑5755916‑441‑33111/0 (CA SP VI)

DC023836PROMENADE DENTAL GROUP3635 N Freeway Blvd Ste 110, 95834‑2926916‑285‑66915/1 (SP)

DC024691 YOLANDA GONZALES DMD2378 Fruitridge Rd, 95822‑3148916‑421‑10101/0 (4 TA)

DC031026SACRAMENTO DENTISTRY GROUP1105 E St, 95814‑0818916‑538‑69005/0 (HI PT SP)

DC032105 MORE SMILES DENTAL2020 Hurley Way Ste 135, 95825‑3298916‑641‑77001/0 (RU SP)

DC037655VINEYARD DENTAL8940 Vintage Park Dr Ste 100, 95829‑1628916‑525‑32001/0

DC039592ELDER CREEK DENTAL GROUP3811 Florin Rd Ste 8, 95823‑1818916‑392‑70201/1 (KO VI)

DC040356STRAWBERRY CREEK DENTAL GROUP8211 Bruceville Rd Ste 155, 95823‑2313916‑525‑76357/0 (SP)

DC040404NATOMAS DENTAL CARE2321 Northgate Blvd, 95833‑2504916‑564‑80881/0 (4 TA)

DC044851WESTERN DENTAL SERVICES8324 Elk Grove Florin Rd, 95829‑9546916‑509‑333455/0

DC046697WESTERN DENTAL SERVICES INC5261 Elkhorn Blvd, 95842‑2506916‑344‑236256/0

DC046698WESTERN DENTAL SERVICES1701 Watt Ave, 95825‑2141916‑973‑120067/0 (SP)

DC046699WESTERN DENTAL SERVICES3645 Northgate Blvd Ste A, 95834‑1641916‑286‑775067/0 (SP)

DC046700 WESTERN DENTAL SERVICES1355 Florin Rd Ste 3, 95822‑4200916‑424‑140046/0

DC050165POCKET DENTAL905 Secret River Dr Ste A, 95831‑3437916‑428‑53181/0

DC054686 Arden Modern Dentistry Dental Group2654 Marconi Ave Ste 100, 95821‑5106916‑437‑01577/0

DC057818 Arden Oaks Dental Care1741 Professional Dr, 95825‑2104916‑485‑55391/0 (HI RU SP)

DC057830Western Dental Services Inc5501 Stockton Blvd, 95820‑5414916‑739‑610047/0

DC057831Western Dental Services Inc5247 Elkhorn Blvd Ste C, 95842‑2509916‑344‑150062/0

DC058670WESTERN DENTAL SERVICES4401 Florin Rd, 95823‑2511916‑428‑400061/0

DC058994Scripps Dental Group79 Scripps Dr Ste 204, 95825‑6208916‑565‑25701/0 (CA CH FR RU SP)

DC060096Star Dental Practice1824 Avondale Ave, 95825‑1378916‑900‑85212/0 (KO SP VI)

DC062215 Sacramento Kids Dentistry2821 Eastern Ave Ste 2, 95821‑5445916‑850‑99991/0 (AR HI SP)

DC062448Reliance Dental Care8876 Vintage Park Dr Ste 105, 95828‑5894916‑681‑27511/0 (KM CH HI SP VI)

DC063008 Ivy Dental Group9700 Business Park Dr Ste 400A, 95827‑1718916‑400‑35521/0 (HI SP)

DC063242Western Dental Services Inc5200 Stockton Blvd, 95820‑5455916‑455‑66005/0 (SP)

DC063247 Western Dental Services Inc3945 Marysville Blvd Ste 1‑2, 95838‑3762916‑646‑41007/0 (SP)

DC063265Western Dental Services Inc2693 Florin Rd, 95822‑4524916‑424‑55006/0 (SP)

DC063988Land Park Modern Dentistry Dental Group3640 Crocker Ave Ste 130, 95818‑3970916‑550‑94292/0 (SP)

DC242901 MADISON DENTAL CARE5149 Madison Ave, 95841‑3001916‑338‑38801/0

DC277101GREENHAVEN DENTAL GROUP925 Secret River Dr Ste A, 95831‑3465916‑421‑38151/0 (SP)

DC322101PIONEER FAMILY DENTAL7850 Stockton Blvd Ste 160, 95823‑4387916‑689‑33103/1 (12 PE SP TA VI)

SalidaDC037923SALIDA DENTAL GROUP5708 Pirrone Rd, 95368‑9313209‑543‑38880/1 (12 SP)

35

DeltaCare® USA

SalinasDC033434DIAMOND DENTAL OF SALINAS1209 N Davis Rd, 93907‑1996831‑424‑41111/0 (TA TA)

DC036336WESTERN DENTAL SERVICES1229 N Main St, 93906‑2826831‑442‑800033/5 (SP)

DC036344WESTERN DENTAL SERVICES921 S Main St # A, 93901‑2435831‑783‑316035/7 (SP)

DC037257ACCU DENTAL929 N Main St, 93906‑3912831‑783‑13360/1 (AR FR HI KO 12 PE SP TA VI)

San BrunoDC029379SAN BRUNO DENTAL CARE211 El Camino Real, 94066‑4838650‑589‑47841/0 (SP TA)

DC336601 EUGENE ESPRITU1230 El Camino Real Ste K, 94066‑1300650‑875‑68080/1 (SP TA TA)

San FranciscoDC014142CENTER OF COSEMTIC DENTISTRY1550 Lombard St, 94123‑3154415‑921‑55550/1 (AR KO SP TA)

DC022751KAYVAN KAFAYI DDS450 Sutter St Rm 1433, 94108‑4010415‑398‑23601/0 (CH RU)

DC023138 ROBERTO CALABIO DMD INC3184 22nd St, 94110‑3232415‑642‑20501/0 (TA)

DC033063MICHAEL COLE DDS2595 Mission St Ste 308, 94110‑2574415‑647‑91911/0 (SP)

DC058401GENTLE DENTAL2494 Mission St, 94110‑2415415‑821‑12004/2 (SP)

DC059169Dental Arts Practice Dr Albina Batchaeva450 Sutter St Rm 1925, 94108‑4107415‑757‑06041/0 (RU)

DC061674 Western Dental Services Inc2626 Mission St, 94110‑3102415‑285‑750021/0 (SP)

DC082801BERNARDO GONZALEZ DDS2720 24th St, 94110‑4212415‑282‑45662/0 (SP)

DC132801 GRAND MISSION DENTAL GROUP4749 Mission St, 94112‑2729415‑469‑74441/0 (SP TA)

DC134701MIKHAIL BERDICHEVSKY DDS4444 Geary Blvd Ste 303, 94118‑3045415‑386‑55902/0 (RU)

DC150101SAN BRUNO AVE DENTAL CLINIC2817 San Bruno Ave, 94134‑1510415‑656‑28681/0 (CA CH 12 SP)

DC184601NORIEGA DENTAL3749 Noriega St, 94122‑3903415‑661‑88511/0 (CA)

DC212701 VAN NESS DENTAL GROUP2243 Van Ness Ave Ste 201, 94109‑2504415‑441‑20981/0 (CA CH HI KO 12)

DC213501SOUTH VAN NESS DENTAL GROUP240 Shotwell St Ste 230, 94110‑1323415‑431‑97971/1 (SP)

DC265501MAT KIISK DDS3100 19th Ave, 94132‑2006415‑584‑25371/0 (Estonian12 SP TA)

San JoseDC003503STORY DENTAL HEALTH CENTER INC2454 Story Rd, 95122‑1058408‑272‑08881/1 (HI PT SP)

DC011864EVERGREEN VALLEY DENTAL4868 San Felipe Rd Ste 120, 95135‑1278408‑528‑83031/0 (HI)

DC013295BIG SMILES DENTAL CARE1547 Saratoga Ave, 95129‑4938408‑725‑37401/0 (SP VI)

DC017363SILICON DENTAL2060 Aborn Rd Ste 210, 95121‑1585408‑238‑55000/1 (HI SP)

DC019242KINI DENTAL CARE100 Oconnor Dr Ste 23, 95128‑1638408‑998‑83831/0 (HI)

DC024850PORTIA DELA VEGA OBLEA DMD2356 Senter Rd, 95112‑2615408‑993‑99391/0 (SP TA)

DC025083PRO‑TECH DENTAL CARE2664 Berryessa Rd Ste 210, 95132‑2907408‑258‑89031/0 (VI)

DC026187KINI GENTLE DENTAL CARE827 Blossom Hill Rd Ste W5, 95123‑2701408‑226‑10600/1 (HI SP)

DC033735GURDIP NARULA DDS2850 Quimby Rd Ste 145, 95148‑2939408‑274‑50002/0 (AM HI SP)

DC036198DENTAL SOLUTIONS2680 S White Rd Ste 100, 95148‑2078408‑531‑95011/0 (HI SP)

DC036353 WESTERN DENTAL SERVICES1871 Camden Ave, 95124‑2945408‑377‑570052/11

DC036417BERNA SANAYEI DDS2929 The Villages Pkwy, 95135‑1442408‑274‑95541/0 (SP TR)

DC037258ACCU DENTAL730 Story Rd Ste 5, 95122‑2624408‑998‑10880/1 (AR HI KO PE SP)

DC037313UNISMILE6134 Camino Verde Dr Ste G, 95119‑1431408‑226‑16000/1 (HI SP)

DC042504BLOOSOM HILL DENTAL CENTER704 Blossom Hill Rd Ste 100, 95123‑5403408‑363‑87001/0 (HI SP)

DC045738HANA FAMILY DENTAL374 S Redwood Ave, 95128‑5110408‑386‑13831/0

DC050214PBS A DENTAL CORPORATION750 N Capitol Ave Ste C8, 95133‑1942408‑926‑22211/0 (SP TA)

DC057368 Western Dental Services1110 S King Rd Ste 60, 95122‑2118408‑273‑725163/0 (SP)

DC057588 Union Dental175 Bernal Rd Ste 260, 95119‑1343408‑365‑97911/0 (KO SP VI)

DC057599 Refresh Dental Group266 N Jackson Ave Ste 1, 95116‑1606408‑272‑19991/0 (CA 12 VI)

DC058650 John Vu DMD583 Willow St, 95125‑5713408‑642‑11441/0 (SP VI)

DC059308Winchester Dental Place1399 S Winchester Blvd Ste 120, 95128‑4309408‑370‑77671/0 (SP VI)

DC059310Guadalupe Dental Care2593 S King Rd Ste 9, 95122‑1880408‑238‑48241/0 (SP VI)

DC059885AZ Dental5730 Cottle Rd Ste 240, 95123‑3764408‑227‑60001/0 (AR FR GR SP VI)

DC059921AZ Dental Corporation405 Saratoga Ave Ste 60, 95129‑1326408‑247‑55001/0 (AR FR GR HI SP VI)

DC060139Pannu Dental Group1569 Lexann Ave Ste 212, 95121‑1795408‑270‑28471/0 (HI SP TA)

DC060246Muhusin Family Dental5150 Graves Ave Ste 11E, 95129‑5014408‑409‑26491/0

36

DeltaCare® USA

DC060306Almaden Dental Care5595 Winfield Blvd Ste 102, 95123‑1220408‑224‑52001/0 (12)

DC060524ACCU DENTAL & ORTHODONTICS1180 Blossom Hill Rd Ste 4, 95118‑3114408‑978‑25001/0 (HI KO SP TA VI)

DC061217David Jou Dental Corporation91 N Bascom Ave, 95128‑1803408‑926‑23311/0

DC062018Young Dental Corporation1705 Branham Ln Ste B4, 95118‑5222408‑264‑76301/0 (KO SP)

DC062152Western Dental Services Inc451 Blossom Hill Rd, 95123‑3302408‑337‑362220/0 (HI SP)

DC062838 Rachna Pall DDS2323 Montpelier Dr Ste B, 95116‑1611408‑258‑40401/0 (HI SP)

DC063064Evergreen Family Dental Group1620 E Capitol Expy Ste C, 95121‑1860408‑223‑60171/0 (HI SP)

DC134901JOEL SANTOS DDS200 N Jackson Ave Ste D, 95116‑1601408‑254‑74911/0 (TA)

DC163301VALLEY FAMILY DENTAL CARE88 Tully Rd Ste 104, 95111‑1923408‑490‑41781/0 (VI)

DC186401JACKSON FAMILY DENTAL2324 Montpelier Dr Ste 3, 95116‑1612408‑937‑59501/0 (PE SP)

San LeandroDC019633ANDY Q V LE DDS1600 150th Ave, 94578‑1824510‑276‑55330/1 (SP VI)

DC036315WESTERN DENTAL SERVICES14895 E 14th St Ste 100, 94578‑2985510‑618‑123040/17 (SP)

DC060414 San Leandro Dental Studio425 Estudillo Ave Ste B, 94577‑4906510‑969‑85101/0 (HR PE SP)

DC060518Sudha Chinta DDS433 Estudillo Ave Ste 302, 94577‑4915510‑351‑09301/0 (HI SP)

DC062414Golden State Smiles15301 Washington Ave, 94579‑1811510‑351‑68205/0 (CA GE HI 12 RU SP)

San MateoDC037686A + DENTAL CENTER400 N San Mateo Dr Ste 2, 94401‑2418650‑343‑08950/1 (CH SP TA)

DC042548 WESTERN DENTAL SERVICES4100 S El Camino Real, 94403‑5131650‑235‑146059/2 (SP)

DC062619 Andrei Roschkowsky DDS351 N San Mateo Dr, 94401‑2513650‑344‑76351/0 (RU SP)

DC2C0001PENINSULA DENTAL401A N San Mateo Dr, 94401‑2417650‑344‑76262/0 (CA CH TA)

San RafaelDC000898SAN RAFAEL DENTISTRY905 Lincoln Ave, 94901‑3331415‑453‑12411/0 (SP)

DC060070EZ Smile Family Dental Group361 3rd St Ste H, 94901‑3580415‑456‑32732/0 (RO RU SP)

DC3C1301 PACIFIC DENTAL GROUP1523 5th Ave, 94901‑1806415‑453‑62770/1 (CA CH 12 SP)

San RamonDC000594COUNTRY FAIR DENTAL12111 Alcosta Blvd, 94583‑2637925‑829‑31111/0 (HI SP)

DC022858SAN RAMON FAMILY DENTAL3160 Crow Canyon Rd Ste 100, 94583‑2090925‑866‑84221/0 (HI)

DC056476 Camino Ramon Dental2301 Camino Ramon Ste 240, 94583‑2029925‑830‑08882/0

DC063473Smile Time Dental9130 Alcosta Blvd. Ste A2, 94583925‑218‑23237/0 (CA SP TA VI)

SangerDC042109KIM HOANG TRAN DDS INC263 Academy Ave, 93657‑2128559‑876‑10311/0 (SP VI)

DC057352H S Mann DDS Inc2514 Jensen Ave Ste 101, 93657‑2451559‑875‑79801/0 (SP)

DC063190United Health Centers of the San Joaquin Valley1570 7th St, 93657‑2402559‑875‑05571/0 (SP)

Santa ClaraDC010498STAR DENTAL980 El Camino Real Ste 250, 95050‑4289408‑247‑37401/0 (HR RU)

DC019966SILICON VALLEY DENTAL2727 Walsh Ave Ste 102, 95051‑0956408‑987‑05301/0 (FR HI SP)

DC041754WESTERN DENTAL SERVICES2825 El Camino Real, 95051‑2901408‑343‑417053/4 (SP)

DC060337NORTHERN DENTAL122 Saratoga Ave, 95051408‑556‑13331/0 (FR HI KO PE SP VI)

Santa CruzDC036338WESTERN DENTAL SERVICES1107 Ocean St, 95060‑2818831‑600‑326035/6 (SP)

DC062694Randall Medefesser DDS550 Water St Ste J1, 95060‑4135831‑425‑55151/0 (SP)

Santa RosaDC021793 ESSENTIAL DENTAL CARE55 Mission Cir Ste 103, 95409‑5372707‑568‑04801/0 (SP)

DC036327WESTERN DENTAL SERVICES4100 Montgomery Dr Ste B, 95405‑5283707‑537‑202128/13 (SP)

DC036813 YUNFEI FAN DDS1420 Guerneville Rd Ste 5, 95403‑4124707‑623‑94711/0 (12 SP)

DC037617 OFFICE OF DR ROSTAMI INC479 Stony Point Rd, 95401‑5969707‑523‑37001/0 (SP)

DC045242WESTERN DENTAL SERVICES1240 Farmers Ln, 95405‑6707707‑542‑520035/14 (HI)

DC046867EZ SMILE FAMILY DENTAL GROUP4757 Hoen Ave, 95405‑7862707‑575‑95952/0 (PE RO RU SP)

DC054681Elite Dental1331 Guerneville Rd Ste G, 95403‑7273707‑526‑39001/0 (AR SP)

DC062465Smile Country Dental140 Stony Point Rd Ste A, 95401‑4121707‑578‑31189/0 (CA HI RU SP)

DC062466NorCal Family Dental Group1144 Sonoma Ave Ste 107, 95405‑4812707‑579‑55332/0 (TR)

DC063201Western Dental Services Inc1144 Sonoma Ave Ste 108, 95405‑4812707‑523‑23997/0 (SP)

SaratogaDC055778 Sepideh Pejham12948 Village Dr Ste D, 95070‑4157408‑255‑90571/0

SelmaDC063112United Health Centers of the San Joaquin Valley2705 Highland Ave, 93662‑3389559‑876‑67031/0 (SP)

South San FranciscoDC039469EPITACIO N SISON JR DDS100 Arroyo Dr Ste C, 94080‑3195650‑878‑31711/0 (TA TA)

37

DeltaCare® USA

DC040747CECILIA R H AVENIDO DMD INC2400 Westborough Blvd Ste 200, 94080‑5402650‑989‑85021/0 (TA TA)

DC057585Union Dental215 Miller Ave, 94080‑3722650‑763‑12231/0 (CH KO SP VI)

DC115101GRAND MISSION DENTAL GROUP1486 Huntington Ave Ste 302, 94080‑5971650‑225‑02021/0 (SP TA)

StocktonDC014339PARK WEST DENTAL GROUP10928 Trinity Pkwy, 95219‑7230209‑474‑80009/2 (SP)

DC024855MARIA THERESA ORONCE DMD1701 N El Dorado St, 95204‑5801209‑292‑87372/0 (SP TA TA)

DC026860SOUTHERN CALIFORNIA DENTAL PRACTICE20 S California St, 95202‑3004209‑941‑08140/1 (CH HI SP)

DC028413STAR DENTAL PRACTICE8626 Lower Sacramento Rd Ste 37B, 95210‑1835209‑951‑80881/0 (KM CH HI SP)

DC031827KEVIN THANG PHAM DDS PC7746 Lorraine Ave Ste 204, 95210209‑475‑08691/0 (SP)

DC036326 WESTERN DENTAL SERVICES1407 W March Ln, 95207‑6111209‑473‑400043/8

DC036906 EDUARDO H ROA DDS1341 W Robinhood Dr Ste C3, 95207‑5516209‑957‑07651/0 (SP)

DC040719 BRIGHT NOW DENTAL‑STOCKTON6323 Pacific Ave, 95207‑3713209‑242‑047010/0

DC042096 WESTERN DENTAL SERVICES678 N Wilson Way, 95205‑4272209‑937‑900042/3

DC042098 WESTERN DENTAL SERVICES7860 West Ln Ste B, 95210‑3317209‑954‑172746/6

DC057612 Pacific Dental Group7743 West Ln Ste C5, 95210‑3381209‑474‑11014/0

DC061704Western Dental Services Inc5756 Pacific Ave Ste 75, 95207‑5156209‑472‑176520/0 (SP)

DC062032Stockton Creative Dental2043 E Fremont St Ste 8, 95205‑5000209‑466‑50001/0 (HI SP)

DC063323 Western Dental Services Inc902 E Hammer Ln, 95210‑3027209‑957‑95004/0

DC063932Western Dental Services Inc616 W Hammer Ln Ste B, 95210‑3749209‑634‑40925/0 (HI SP)

SunnyvaleDC010499SMILESAVERS DENTAL1214 Apollo Way Ste 402, 94085‑5417408‑737‑01011/0 (HI SP)

DC025246LORA COSTA DDS1286 Kifer Rd Ste 110, 94086‑5326408‑774‑12000/1 (RU SP TA VI)

DC063241 Western Dental Services Inc787 E El Camino Real, 94087‑2919408‑990‑864411/0 (SP)

DC178501JOON KU LEE DMD500 E Remington Dr Ste 26, 94087‑2612408‑774‑28281/0 (KO)

DC398201 SUNNYVALE FAMILY DTL CARE990 W Fremont Ave Ste O, 94087‑3065408‑739‑89991/0 (AR HE JA SP)

TracyDC023693GRANTLINE DENTAL2242 W Grant Line Rd Ste 102, 95377‑7329209‑832‑25251/0 (HI SP)

DC029718PARAMJIT SINGH DDS4598 S Tracy Blvd Ste 150, 95377‑8112209‑221‑66661/0 (HI SP)

DC033811TRACY SMILES DTL GRP2600 S Tracy Blvd Ste 170, 95376‑9111209‑836‑54417/2 (SP)

DC036333 WESTERN DENTAL SERVICES2313 N Corral Hollow Rd, 95376‑9401209‑832‑968046/15

DC050886ARCH DENTAL1920 W Grant Line Rd, 95376209‑820‑07891/0 (HI SP)

DC063566Western Dental Services Inc2990 W Grant Line Rd, 95304‑7901209‑830‑77976/0 (SP TA)

TurlockDC014891HEALTHY SMILE DENTAL795 E Olive Ave Ste B, 95380‑4056209‑668‑93000/1 (HI SP)

DC038595WESTERN DENTAL SERVICES703 N Golden State Blvd, 95380‑3953209‑634‑405335/1 (SP)

DC048644TURLOCK SMILES DENTISTRY AND ORTHODONTICS2808 W Monte Vista Ave, 95380‑8409209‑667‑28798/0

DC050212LULETTE A MERCADO DDS FAMILY DENTISTRY1065 Colorado Ave Ste 6, 95380‑2761209‑250‑23001/0 (SP TA)

DC054237 Palm Dental Group241 N Palm St, 95380‑4028209‑667‑22452/0 (KO SP)

DC061824Smile Bright Family Dentistry981 E Tuolumne Rd Ste 110, 95382‑1544209‑667‑54051/0 (HI SP)

UkiahDC052167Ukiah Dental307 Luce Ave, 95482‑5667707‑462‑18811/0 (SP)

Union CityDC039162NOBLE DENTAL CARE34603 Alvarado Niles Rd, 94587‑4598510‑493‑21300/1 (HI)

VacavilleDC010095ALAMO FAMILY DENTAL CARE2501 Nut Tree Rd, 95687‑6759707‑454‑38881/0 (CH RO SP)

DC021426ALAMO DENTAL3057 Alamo Dr, 95687‑6300707‑448‑88811/0 (TA)

DC029121ALL SMILES DENTAL1241 Alamo Dr Ste 11, 95687‑5620707‑447‑82891/0 (12 SP)

DC036322WESTERN DENTAL SERVICES791 E Monte Vista Ave, 95688‑2920707‑359‑221138/22 (SP)

DC039351BAYSIDE DENTAL72 Peabody Rd, 95687‑4727707‑450‑07320/1 (KO SP)

DC050775VACAVILLE DENTAL CENTER141 Parker St Ste B, 95688‑3921707‑450‑10031/0 (HI SP)

DC057251 Vacaville Dentistry and Orthodontics Dental Group671 Elmira Rd Ste 130, 95687‑4655707‑215‑52594/0

VallejoDC022896TRI‑CITY DENTAL VALLEJO3630 Sonoma Blvd, 94590‑2946707‑643‑19871/0 (SP TA)

DC036357 WESTERN DENTAL SERVICES3587 Sonoma Blvd, 94590‑2945707‑557‑800036/22 (SP)

DC044947BAYSIDE DENTAL PRACTICE2121 Redwood St Ste A, 94590‑3603707‑644‑76001/0 (KO SP)

DC056752Mak Dental480 Redwood St Ste 13, 94590‑2958707‑554‑26001/0 (AR FR SP)

38

DeltaCare® USA

DC062078Galvan Dental Care2809 Redwood Pkwy, 94591‑3634707‑643‑08881/0 (12 SP TA TA)

DC063329 Western Dental Services Inc3400 Sonoma Blvd, 94590‑2972707‑554‑40006/0

DC063565Western Dental Services Inc133 Plaza Dr Ste R, 94591‑3703707‑557‑62458/0 (SP)

DC137201JULIUS MOSLEY II DDS2121 Redwood St Ste E, 94590‑3603707‑558‑16601/0 (CH SP)

Valley SpringsDC056441Valley Springs Dental313 Vista Del Lago Dr, 95252‑8348209‑772‑72001/0 (HI SP)

W SacramentoDC035874SOUTH RIVER DENTAL GROUP2455 Jefferson Blvd Ste 130, 95691‑5328916‑372‑80625/0 (SP)

Walnut CreekDC002987TIM PATEL DDS1818 San Miguel Dr, 94596‑8606925‑945‑73661/0 (HI SP)

DC008907SAN MIGUEL DENTAL1844 San Miguel Dr Ste 206, 94596‑4963925‑279‑33260/1 (CH 12 RO SP TA TA)

DC027824DENTAL CARE OF WALNUT CREEK1111 Civic Dr Ste 145, 94596‑8229925‑937‑90173/2 (12 SP)

DC034527HORIZONS DENTAL100 N Wiget Ln Ste 209, 94598‑5901925‑945‑79770/1 (SP TA)

DC062554Dr Ahmad Hakimjavadi DDS1804 San Miguel Dr, 94596‑8606925‑262‑11621/0 (SP)

DC1C9701MIKHAIL BERDICHEVSKY DDS120 La Casa Via Ste 105, 94598‑3094925‑933‑98202/0 (HE RU)

WatsonvilleDC036309WESTERN DENTAL SERVICES1895 Main St, 95076‑6024831‑763‑474336/6 (SP)

DC037259ACCU DENTAL40 Penny Ln Ste 2, 95076‑6008831‑724‑02450/1 (AR FR HI KO 12 PE SP VI)

West SacramentoDC061676Sacramento West Dental Office821 Jefferson Blvd, 95691‑3205916‑372‑33681/0 (HI SP)

WindsorDC191601CHARLES AIKAWA DDS8741 Brooks Rd S Ste 201, 95492‑7854707‑579‑12011/0 (SP)

WoodlandDC025080YOLO DENTAL PRACTICE520 Cottonwood St Ste 9, 95695‑3603530‑662‑81001/0 (CH SP TA)

DC040062WOODLAND SMILES2041 Bronze Star Dr Ste 100, 95776‑5428530‑662‑75925/1 (SP)

DC062616Woodland Family Dental58 W Court St, 95695‑3012530‑668‑55002/0 (HI SP)

Yuba CityDC021422MELISSA LEE DDS1215 Plumas St Ste 1901, 95991‑4027530‑751‑76711/0 (SP)

DC046520 WESTERN DENTAL SERVICES INC727 Colusa Ave, 95991‑3943530‑751‑011556/0

DC063304All Dental and Orthodontics1222 Colusa Ave Ste H, 95991‑3656530‑673‑36842/0 (SP)

DC063327 Western Dental Services Inc940 Colusa Ave Ste A, 95991‑3676530‑755‑99006/0

Northern California offices (closed)AlamedaDC055237 Alameda Landing Dentistry Dental Group2660 5th St Ste C, 94501‑6577510‑384‑400010/0

AntiochDC008248SALAM GHANNAM DDS2225 Buchanan Rd Ste A, 94509‑4209925‑779‑11120/1 (SP)

DC0C1001DENTAL CARE OF ANTIOCH3432 Hillcrest Ave Ste 250, 94531‑6303925‑754‑21451/0 (SP)

AuburnDC062004Modern Dentistry of Auburn185 Palm Ave, 95603‑3711530‑885‑65591/0

BerkeleyDC042286BERKELEY FAMILY DENTAL3000 Colby St Ste 302, 94705‑2058510‑843‑44500/1 (CH HI SP)

Citrus HeightsDC165301FIRST DENTAL6191 Greenback Ln Ste A, 95621‑4796916‑723‑53301/0 (VI)

ClaytonDC049635PERFECT SMILES FAMILY DENTISTRY1026 Oak St Ste 206, 94517‑1363925‑889‑92121/0 (PT TA)

ClovisDC152901MICHAEL WARD DDS375 Bullard Ave Ste 3, 93612‑1056559‑298‑74241/0

Daly CityDC062695Serramonte Ridge Dental901 Campus Dr Ste 304, 94015‑4930650‑756‑19001/0

Elk GroveDC058597Fernandez Dental Office9320 Elk Grove Blvd Ste 170, 95624‑5061916‑714‑54221/0 (SP)

Fair OaksDC056770 FAIR OAKS QUALITY DENTAL11622 Fair Oaks Blvd Ste 103, 95628‑3768916‑903‑76441/0

FremontDC025567 DUC NGUYEN DDS39411 Fremont Blvd, 94538‑2116510‑438‑92011/0 (CH SP VI)

DC026181 ADVANCED SMILE DESIGN39560 Stevenson Pl Ste 117, 94539‑3074510‑797‑81001/0 (HI TA)

DC052427 Anil Chowdhary3200 Mowry Ave Ste A, 94538510‑648‑24871/0 (HI SP TA)

FresnoDC008872 NORTHSIDE DENTAL PRACTICE1440 E Champlain Dr Ste 101, 93720559‑446‑13502/0 (KM SP VI)

LivermoreDC044891 ALTA VISTA DENTAL3183 Independence Dr, 94551‑7595925‑292‑14590/1 (RU)

LodiDC036343 WESTERN DENTAL SERVICES320 S Cherokee Ln, 95240‑4266209‑366‑797039/7

Mountain ViewDC170301 PARKTOWN DENTAL CARE990 Bay St, 94040‑2681650‑968‑40001/0 (SP TA TA)

NovatoDC053682 Novato Smiles Dentistry Dental948 Diablo Ave, 94947415‑897‑80204/0 (SP)

OaklandDC017481 BAY AREA DENTAL3300 Webster St Ste 907, 94609‑3156510‑350‑81871/0 (RU)

DC024221 OAKLAND DENTAL CARE315 14th St, 94612510‑444‑63001/0 (SP)

39

DeltaCare® USA

DC138201 WAYNE FONG DDS1624 Franklin St Ste 410, 94612‑2822510‑444‑10831/0 (SP)

PleasantonDC061196 Gokani Dental Corporation1024 Serpentine Ln Ste 114, 94566‑4716925‑462‑14641/0 (HI)

RocklinDC046713 DESTINY DENTAL IMPLANT CENTER6950 Destiny Dr, 95677‑2987916‑672‑63771/0

RosevilleDC000667 SIERRA COLLEGE DENTAL PRACTICE9290 Sierra College Blvd Ste 300, 95661‑5991916‑788‑84501/0 (HI SP TA VI)

DC001704 AMERICAN FAMILY DENTISTRY1160 Cirby Way Ste 100, 95661‑4422916‑789‑85302/0 (SP)

SacramentoDC036898 NEW ESSENCE DENTISTRY4000 Truxel Road Ste 2, 95834‑3726916‑515‑10002/0 (SP)

DC114901 SERENA PUGEDA DMD2518 L St Ste A, 95816‑5655916‑446‑77683/0 (SP TA TA)

San CarlosDC059467 Laurel Dental San Carlos1267 Laurel St, 94070‑5015650‑381‑48111/0 (CA CH 12 SP)

San JoseDC002706 IRMA FRANCISCO DDS INC4750 Almaden Expy Ste 152, 95118‑2052408‑264‑58801/0 (SP TA)

DC009619 UNIDENT2390 Senter Rd, 95112‑2616408‑298‑64201/0 (SP VI)

DC021004 UNI DENTAL175 S Capitol Ave Ste E, 95127‑2845408‑923‑30731/0 (SP VI)

DC033366 ONE STOP DENTAL1155 S King Rd, 95122‑2144408‑928‑56782/0 (SP VI)

DC036318 WESTERN DENTAL SERVICES48 E Santa Clara St, 95113‑1805408‑293‑700057/11 (SP VI)

DC042546 S J DENTAL1876 Curtner Ave Ste 100, 95124‑1141408‑371‑73911/0 (CA CH 12 SP VI)

DC049647 GORDON K KANAGAKI DDS INC7176 Santa Teresa Blvd Ste B4, 95139‑1351408‑226‑77601/0

DC162401 BLOSSOM HILL FAMILY DENTAL5058 Union Ave Ste A, 95124‑5432408‑559‑86681/0 (SP VI)

San LeandroDC046440 SELECT DENTAL145 E 14th St Ste 100, 94577‑1661510‑587‑94002/0 (SP VI)

Santa RosaDC013132 BRIGHT CARE DENTAL1420 Guerneville Rd Ste 2, 95403‑4124707‑578‑37761/0

DC056682 Coddingtown Dental Care1801 Cleveland Ave Ste C, 95401‑8813707‑545‑33382/0 (HI SP)

South San FranciscoDC014628 TRINITY DENTAL CARE1124 Mission Rd, 94080‑1301650‑872‑30300/0 (TA)

DC052919 Maria Luisa B Santos125 Northwood Dr Ste A, 94080‑5755650‑873‑47401/0 (SP TA)

StocktonDC000689 Rommel K Bal DDS Inc1545 Saint Marks Plz Ste 1, 95207‑6411209‑957‑12441/0 (HI SP)

SunnyvaleDC028978 SAI DENTAL1050 E El Camino Real, 94087‑3754408‑423‑91971/0 (HI)

VacavilleDC039771 NUT TREE SMILES DENTISTRY110 Nut Tree Pkwy, 95687‑3251707‑451‑83905/1 (SP)

WoodlandDC019690 LINCOLN DENTAL520 Cottonwood St Ste 11, 95695‑3603530‑661‑92762/0 (SP)

Southern California offices (open)Agoura HillsDC022091 AGOURA DENTAL5809 Kanan Rd, 91301‑1651818‑735‑38001/0 (GE SP)

DC044928 SEA BREEZE DENTAL CARE5029 Kanan Rd, 91301‑2515818‑991‑98529/1 (RU SP)

AlhambraDC025939 JIN ZHANG DDS1711 W Main St, 91801‑1827626‑308‑17111/0 (CA CH JA SP)

DC0C0201 ALHAMBRA GARFIELD DENTAL INC747 S Garfield Ave, 91801‑4438626‑289‑68152/0 (SP)

Aliso ViejoDC044625 GUITTA HARB DMD INC26731 Aliso Creek Rd Ste 210, 92656‑4811949‑360‑02251/0 (AR FR SP)

DC056971 ALISO VIEJO DENTAL26921 Aliso Creek Rd Ste B, 92656‑3395949‑425‑14471/0 (SP)

Alta LomaDC061193 Smile360 Family Dentistry9778 19th St, 91737‑3538909‑980‑48782/0 (AR HI SP)

AnaheimDC003047 STATE COLLEGE DENTAL GROUP330 N State College Blvd Ste 105, 92806‑2943714‑772‑5005 0/3 (PE SP)

DC004784 BRIGHT NOW DENTAL150 N State College Blvd, 92806‑2909714‑780‑085617/0 (SP)

DC013160 MAYSOON SAEED DDS INC710 S Brookhurst St Ste K, 92804‑4321714‑758‑07781/0 (AR)

DC013174 BRITE DENTAL GROUP1221 N Harbor Blvd, 92801‑2421714‑224‑49990/1 (SP)

DC013770 7 DAY DENTAL2265 W Lincoln Ave, 92801‑6503714‑491‑86000/5 (CH FR JA KO PE SP TA VI)

DC014097 SUNKIST DENTAL OFFICE2500 E Ball Rd Ste 150, 92806‑5000714‑533‑96700/1 (HI)

DC021442 EXCEL DENTAL1602 N Lemon St, 92801‑1205714‑525‑55581/0 (SP VI)

DC025173 DENTAL HEALTH ANAHEIM HILLS8101 E Kaiser Blvd Ste 150, 92808‑2661714‑921‑92520/1 (HI SP)

DC026769 NOEMI TAGUINOD DENTAL408 S Beach Blvd Ste 113, 92804‑1876714‑816‑09541/0 (SP TA)

DC030551 DENTAL AESTHETICS PROFESSIONALS1751 W Romneya Dr Ste D, 92801‑1815714‑772‑35380/1 (SP TA)

DC034491 CALIFORNIA DENTAL GROUP2300 S Harbor Blvd, 92802‑3518714‑750‑30300/1 (SP VI)

40

DeltaCare® USA

DC035597 BEACH DENTAL CARE2940 W Lincoln Ave Ste L, 92801‑6200714‑995‑40000/1 (KO SP)

DC038727 ROSETTA VERGEL DE DIOS DMD1691 S Euclid St, 92802‑2406714‑991‑75721/0 (SP TA)

DC042526 WESTERN DENTAL SERVICES INC1696 W Katella Ave, 92802‑3015714‑635‑600043/2

DC044688 YOUROCDENTISTCOM1116 N Euclid St, 92801‑1955714‑635‑08551/0 (AR AM FR SP)

DC047149 YOUR DENTIST3174 W Lincoln Ave Ste 102, 92801‑6085714‑826‑50001/0 (SP TA VI)

DC048191 HILLSVIEW DENTAL414 S Anaheim Hills Rd, 92807‑4241714‑974‑52231/0

DC052114 NA DENTAL1830 W Lincoln Ave Ste G‑F, 92801‑6746714‑491‑00821/0 (KO SP)

DC057984 Crescent Family Dental522 N Magnolia Ave, 92801‑4937714‑828‑14151/0 (CH SP)

DC058562 Smiles for Orange Country9672 Ball Rd, 92804‑5309714‑772‑01022/0 (HI SP)

DC058791 Radiance Dental5675 E La Palma Ave Ste 197, 92807‑2107714‑695‑05931/0 (AR)

DC059496 Neeta Somani DDS Inc1842 W Lincoln Ave Ste B, 92801‑5489714‑533‑43211/0 (HI SP)

DC060588 California Dental Group of North Anaheim1221 N Euclid St, 92801‑1954714‑491‑27321/0 (PL SP)

DC060680 San Angel Dental1637 S Euclid St, 92802‑2406714‑998‑12221/0 (SP)

DC061124 Patriot Dental922 S Euclid St, 92802‑1523714‑776‑70151/0 (SP VI)

DC061165 Dentists of Anaheim Hills Dental Group8162 E Santa Ana Canyon Rd Ste 104, 92808‑1112714‑202‑07652/0 (SP)

DC061389 Westport Dental420 S State College Blvd, 92806‑4119714‑772‑07701/0 (SP VI)

DC062030 Impladent Implant and Cosmetic Dentistry1520 E Lincoln Ave Ste 2, 92805‑2261714‑774‑63301/0 (AM PE SP)

DC062140 Welcome Dentistry1201 N Euclid St, 92801‑1954714‑817‑83452/0 (KO SP VI)

DC062499 Apple Tree Dental2170 W Lincoln Ave, 92801‑5601714‑907‑06061/0 (KO SP)

DC063041 Ace Dental Group1007 W La Palma Ave Ste 3, 92801‑3620714‑778‑61602/0 (KO SP)

DC063273 Anaheim Smiles Dental5475 E La Palma Ave Ste 200, 92807‑2075657‑341‑37002/0 (FinnishGE KO 12 SP TA)

DC063415 Dental Wellness of Anaheim250 W Lincoln Ave, 92805‑2903714‑535‑32541/0

DC063952 Anaheim Hills Dental Arts100 S Chaparral Ct Ste 150, 92808‑2284714‑637‑42001/0 (HI SP)

DC188001 DANNY THOMAS DDS601 S Euclid St, 92802‑1233714‑778‑07000/1 (SP)

DC256501 DR. JOHN M DELANEY DENTAL CORPORATION1161 N Euclid St, 92801‑1938714‑999‑50502/0 (SP)

DC258301 DENTAL CARE OF ANAHEIM815 N Euclid St, 92801‑4128714‑758‑07910/1 (HI SP)

DC274701 ANAHEIM OPEN 7 DAYS DENTAL637 N Euclid St, 92801‑4621714‑772‑28930/5 (KM CA CH LO 12 SP TA TA VI)

DC3C2201 ANAHEIM HILLS DENTAL GROUP5731 E Santa Ana Canyon Rd Ste A, 92807‑3234714‑998‑295610/2 (SP)

Apple ValleyDC008689 GENTLE DENTAL APPLE VALLEY18245 US Highway 18 Ste 3, 92307‑2217760‑242‑29772/0

DC022889 APPLE VALLEY SMILES12218 Apple Valley Rd Bldg 1 Ste 1, 92308‑1704760‑300‑36785/2 (SP)

DC023235 PARKWAY DENTAL GROUP20258 US Highway 18 Ste 400, 92307‑6197760‑646‑88393/1 (SP)

DC024165 DEXTER DENTAL GROUP INC19195 US Highway 18 Ste 201, 92307‑2562760‑242‑07965/0 (SP TA)

DC036527 SUNBURST DENTAL17995 US Highway 18 Ste 2, 92307‑2190760‑946‑52001/0 (SP)

DC047378 WESTERN DENTAL SERVICES INC19071 Bear Valley Rd Ste 1, 92308‑2718760‑810‑406656/0 (SP)

DC051120 JESS RANCH DENTAL18805 Bear Valley Rd Ste 4, 92308‑2728760‑961‑70011/0 (SP)

DC055387 Apple Valley Dental Associates20162 US Highway 18 Ste L, 92307‑2935760‑946‑14661/0 (KO SP)

DC062277 Valley Desert Dentist21580 Bear Valley Rd Ste B2‑2, 92308‑7200760‑503‑92332/0

ArcadiaDC011037 KAI WU DDS INC906 S Baldwin Ave, 91007‑6703626‑462‑98901/0 (CH JA 12 SP)

DC018884 SANTA ANITA DENTAL GROUP721 W Huntington Dr Ste B, 91007‑6734626‑574‑17667/1 (SP)

DC028125 ARCADIA DENTAL GROUP111 E Live Oak Ave, 91006‑5240626‑445‑11811/2 (CA 12 SP)

DC029181 JASON GEE DDS INC638 W Duarte Rd Ste 9, 91007‑9203626‑447‑78771/0 (CH 12 SP)

DC040824 OMID FARAHMAND DMD289 W Huntington Dr Ste 313, 91007626‑254‑19480/1 (AR FR JA PE SP)

DC196501 ARCADIA DENTAL CENTER440 E Huntington Dr Ste 101, 91006‑3750626‑447‑51263/1 (AM SP)

ArletaDC000223 SIMA BOOSTANFAR DMD9069 1/2 Woodman Ave, 91331‑6463818‑893‑87991/0 (SP)

DC054264 Planet Dental9700 Woodman Ave Ste A29, 91331‑6459818‑897‑19991/0 (HI KO SP TA VI)

DC059712 Woodman Dental Care8725 Woodman Ave Ste B, 91331‑6562818‑891‑66701/0 (SP TA)

Arroyo GrandeDC050262 R & R DENTAL CARE236 S Halcyon Rd, 93420‑3118805‑489‑14958/0 (SP)

41

DeltaCare® USA

ArtesiaDC000733 SARAH CUPINO DMD12146 South St Ste E, 90701‑6844562‑924‑10071/0 (SP TA)

DC042287 AARTI SHAH DDS INC17613 Pioneer Blvd, 90701‑4008562‑809‑84820/1 (AR HI KO SP VI)

DC055230 LEE AND KIM DENTAL CORP17334 Pioneer Blvd, 90701‑2708562‑924‑33341/0 (KO SP)

DC112201 SIOE HWA ONG DDS INC17906 Pioneer Blvd Ste 100, 90701‑4417562‑860‑96121/1 (IN)

AzusaDC012598 JAMES AHN DDS INC315 E Gladstone St, 91702‑4928626‑969‑67281/0 (SP)

DC033796 BRIGHT NOW DENTAL‑AZUSA810 E Alosta Ave, 91702‑2706626‑804‑21443/1

DC045234 ST JOHN DENTAL910 E Gladstone St, 91702‑4747626‑332‑30001/0 (AR SP)

DC053831 Canyon City Dental706 N Azusa Ave, 91702‑2507626‑334‑73102/0

DC063268 Hesam Shahoveisi DMD Inc483 S Citrus Ave, 91702‑4734626‑966‑34001/0 (SP)

BakersfieldDC012136 BAKERSFIELD DENTAL GROUP5120 Stockdale Hwy Ste D, 93309‑2673661‑324‑54423/0 (SP)

DC012986 RIVER LAKES DENTAL GROUP9510 Hageman Rd Ste B, 93312‑3953661‑829‑27009/1 (FR SP VI)

DC013335 ROBERT REDELSPERGER DDS2106 20th St, 93301‑3711661‑324‑60531/0 (SP)

DC013485 BHASKAR JOSHI DDS INC2519 River Blvd, 93305‑2651661‑873‑96321/0 (HI SP)

DC020014 HOME CARE DENTAL5917 Niles St Ste 3, 93306‑4695661‑366‑65271/1 (AR SP)

DC020863 MERCY PLAZA DENTAL GROUP500 Old River Rd Ste 225, 93311‑9508661‑663‑01092/0 (GE SP)

DC033092 MILLENNIUM DENTAL CENTER1830 28th St, 93301‑1904661‑326‑85360/2 (AR SP)

DC042486 WESTERN DENTAL SERVICES4401 Ming Ave, 93309‑4817661‑397‑740038/3 (SP)

DC042487 WESTERN DENTAL SERVICES1201 24th St # A, 93301‑2300661‑431‑112031/4 (SP)

DC042519 WESTERN DENTAL SERVICES3401 Coffee Rd Ste A, 93308‑5080661‑587‑351235/2 (SP)

DC043525 GOSFORD VILLAGE DNTL GROUP5353 Gosford Rd Ste 103, 93313‑4969661‑588‑20654/2 (SP)

DC045321 STOCKDALE SMILES DENT & ORTH11120 Stockdale Hwy Ste 103, 93311‑3656661‑665‑00808/0 (SP)

DC061146 Guy W. Mendivil DDD Professional Dental Corp515 W Columbus St Ste A & B, 93301‑5847661‑323‑59101/0 (SP)

DC062469 Ocean Dental Group2750 Ming Ave, 93304‑4431661‑396‑17012/0 (AR SP)

DC062689 San Dimas Dental Practice3809 San Dimas St Ste A, 93301‑5727661‑322‑76961/0 (SP TA)

DC062703 Dentists of Bakersfield of Dental Group1403 Allen Rd Ste 1000, 93314661‑368‑09192/0 (SP)

Baldwin ParkDC000313 PRAKASH PATEL DDS4138 Maine Ave Ste N3, 91706‑3302626‑960‑63950/1 (SP)

DC029898 BALDWIN PARK FAMILY DENTAL13020 Francisquito Ave Ste 7, 91706‑3753626‑962‑94741/0 (KO SP)

DC056766 San Jose Yangon Dental14514 Ramona Blvd Ste 1, 91706‑3361626‑337‑47001/0 (CH SP)

BanningDC036281 WESTERN DENTAL SERVICES887 W Ramsey St, 92220‑4437951‑849‑321455/11 (SP)

DC048549 BANNING FAMILY CENTER1070 E Ramsey St, 92220‑5924951‑846‑25603/0 (GE 4 SP)

DC057219 Dental Works6350 W Ramsey St Ste A, 92220‑3065951‑769‑04661/0 (AR FR RO SP)

BarstowDC023900 PROCARE DENTAL GRP1232 E Main St, 92311‑2409760‑256‑11891/0 (SP TA TA)

BeaumontDC026912 BEAUMONT SMILES DENTAL GROUP1620 E 2nd Street Market Place Ste A, 92223‑3166951‑769‑91316/1 (SP)

DC059832 DR LEE BEAUMONT DENTAL930 Beaumont Ave, 92223‑1831951‑845‑22001/0 (KO SP)

DC062788 The Dental Office of Beaumont1620 E First St Ste 200, 92223‑3174951‑800‑80952/0 (SP)

BellDC012292 KAMRAN HAKIM DDS6334 Atlantic Ave, 90201‑1228323‑560‑36460/1 (SP)

DC013144 DR DESAI‑GAGE FAMILY DENTAL4127 Gage Ave, 90201‑1128323‑773‑29312/0 (SP)

Bell GardensDC055522 BRIGHT NOW DENTAL‑BELL GARDENS6840 Eastern Ave Ste A, 90201323‑513‑084216/0

DC328401 MARKETPLACE DENTAL OFFICE6815 Eastern Ave Ste A1, 90201‑3919323‑560‑25950/1 (SP)

DC372001 JIN WEI CHU DDS6526 Eastern Ave, 90201‑3004323‑771‑39492/0 (CH 12 SP)

BellflowerDC003208 ROSECRANS DENTAL GROUP9222 Rosecrans Ave, 90706‑2140562‑272‑02220/4 (PE SP VI)

DC010634 SMILE CENTER DENTAL16542 Bellflower Blvd Ste 100, 90706‑5417562‑866‑70730/1 (SP)

DC019923 BELLFLOWER DENTAL17615 Lakewood Blvd, 90706‑6409562‑408‑144713/0

DC046702 WESTERN DENTAL SERVICES INC9755 Alondra Blvd, 90706‑3677562‑925‑402266/0 (SP)

DC059299 Western Dental Services Inc17660 Lakewood Blvd, 90706‑6410562‑461‑118023/0

DC059549 Bruce J Uy DMD Dental Corporation16900 Lakewood Blvd Ste 306, 90706‑5580562‑867‑51912/0 (SP TA TA)

DC060041 Alexander Santos Flores DMD Inc10454 Artesia Blvd Ste C, 90706‑6838562‑925‑58991/0 (SP TA)

42

DeltaCare® USA

DC062191 Bellflower Smile Center9202 Alondra Blvd, 90706‑4210562‑246‑99891/0 (RU SP)

DC062285 Alondra Dental Associates8800 Alondra Blvd Ste A, 90706‑4302562‑317‑49173/0 (SP)

DC329301 JOHN LIM DMD10120 Alondra Blvd, 90706‑3904562‑920‑66441/0 (SP TA)

Beverly HillsDC005483 GALLERY DENTAL ARTS9400 Brighton Way Ste 309, 90210‑4710310‑273‑73971/0 (AM RU)

DC026347 SMILE ANGELS OF BEVERLY HILLS8500 Wilshire Blvd Ste 709, 90211‑3105310‑201‑90011/0 (FR GR SP)

DC057362 Montage Cosmetic Dental9400 Brighton Way Ste 210, 90210‑4709310‑270‑42221/0 (SP)

DC255201 STEVEN GOLDY AND ASSOCIATES416 N Bedford Dr Ste 102, 90210‑4308310‑550‑15111/0 (AM HE RU SP)

DC305001 KAMBIZ KASHFIAN DDS50 N La Cienega Blvd Ste 206, 90211‑2246310‑659‑79491/0 (AM FR SP)

BonitaDC013283 BONITA FAMILY DENTAL4424 Bonita Rd, 91902‑1423619‑479‑87031/1 (HR RU SP TA)

BreaDC025689 SHEENA BHATIA DDS151 S Kraemer Blvd Ste C1, 92821‑4672714‑257‑92001/0 (HI SP)

DC035011 BRIGHT NOW DENTAL‑BREA101 W Imperial Hwy Ste E, 92821‑7902714‑988‑100010/0

DC036008 FULLERTON DENTAL CARE747 S Brea Blvd Ste 34, 92821‑5379714‑870‑20001/1 (SP)

DC039541 CATHERINE NGUYEN DDS INC552 E Lambert Rd, 92821‑4116714‑990‑33440/1 (SP VI)

DC040105 BREA DENTISTS & ORTHODONTISTS2500 E Imperial Hwy Ste 120, 92821‑6116714‑990‑22994/0 (SP)

DC040782 COSMETIC & DENTAL IMPLANT CENTER782 N Brea Blvd, 92821‑3334714‑257‑03300/1 (KO SP VI)

DC041994 KAREN KOO DDS936 E Imperial Hwy, 92821‑5612714‑990‑49111/1 (SP)

DC057441 Brea Dental Care330 N Brea Blvd Ste B, 92821‑4001562‑356‑09482/0 (AR FR JA PT SP VI)

DC058386 Gental Dental Brea715 E Birch St Ste A, 92821‑5704714‑332‑10063/0 (AR SP)

DC061821 Brea Dental Group503 E Imperial Hwy, 92821‑5544714‑672‑90001/0

DC1C4801 BERRY IMPERIAL DENTAL GROUP649 W Imperial Hwy Ste H, 92821‑3838714‑529‑12321/0 (SP)

DC3C1501 IMPERIAL DENTAL CARE200 E Imperial Hwy, 92821‑4925714‑671‑99992/1 (AR FR HE HI SP VI)

Buena ParkDC012353 FOROUTAN DENTAL CORPORATION8951 Knott Ave Ste L, 90620‑4108714‑826‑41811/0 (SP TA)

DC023298 VALLEY VIEW DENTAL10102 Valley View St, 90620‑4344714‑229‑48980/1 (SP)

DC029969 P DHOLAKIYA & ASSOCIATES DDS7011 Orangethorpe Ave Ste 100, 90621‑3322714‑994‑44820/2 (SP)

DC036324 WESTERN DENTAL SERVICES5971 Lincoln Ave, 90620‑3580714‑995‑935935/13 (SP)

DC036557 ALL SMILES DENTAL7938 Valley View St, 90620‑2354714‑670‑76570/1 (SP)

DC042829 PRIME DENTAL CARE7540 Orangethorpe Ave Ste C4, 90621‑3458714‑522‑44451/0 (KO SP)

DC045697 BRITE DENTAL5258 Beach Blvd Ste A, 90621‑1276714‑523‑28281/0 (KO)

DC061497 DENTISTS OF BUENA PARK DENTAL GROUP7540 Orangethorpe Ave Ste A1, 90621‑3458714‑576‑25404/0 (SP)

DC062777 Buena Park Dental Center8402 Commonwealth Ave, 90621‑2528714‑739‑20511/0 (SP)

DC063962 Heungki Min DDS A Professional Corp5881 Beach Blvd, 90621‑2021714‑266‑03781/0 (KO SP)

DC157001 ST THERESE FAMILY DENTISTRY6891 La Palma Ave, 90620‑2429714‑994‑69111/0 (TA)

BurbankDC000082 SAN GABRIEL SUMMIT DENTAL255 E Orange Grove Ave Ste B, 91502‑1240818‑557‑09641/0 (SP)

DC011035 LOUIS MO DDS500 E Olive Ave Ste 460, 91501‑2171818‑846‑31811/0 (SP)

DC011528 EMPIRE DENTAL GROUP1635 N Victory Pl, 91502‑1645818‑565‑00579/1 (SP)

DC012934 TOLUCA LAKE DENTAL3808 W Riverside Dr Ste 408, 91505‑5301818‑842‑40191/0 (SP)

DC013523 BURBANK‑GLENDALE DENTAL GROUP500 E Olive Ave Ste 430, 91501‑2171818‑567‑46621/0 (RU SP)

DC015675 CASTLE DENTAL CENTER140 N Victory Blvd Ste 101, 91502‑1848818‑841‑163417/1 (SP)

DC022062 VIGEN ALIKHANIAN DDS3927 W Burbank Blvd, 91505‑2118818‑845‑09001/0 (AM RU SP)

DC024660 BOYAJIAN & BARDAKJIAN DDS3808 W Riverside Dr Ste 307, 91505‑4339818‑861‑78401/0 (AR AM RU)

DC035522 BURBANK VILLAGE DENTISTRY928 N San Fernando Blvd Ste E, 91504‑4318818‑841‑86071/0 (AM RU SP TA)

DC058001 WESTERN DENTAL SERVICES INC1107 N San Fernando Blvd, 91504‑4331818‑295‑256640/0 (PE SP)

DC063032 Midtown Dental Group4406 W Magnolia Blvd Ste A, 91505‑2729818‑260‑02741/0

DC0C4301 RENE GHOTANIAN DDS500 E Olive Ave Ste 250, 91501‑2171818‑846‑26001/0 (AM SP)

DC236001 JOHN YEKIKIAN DDS2601 W Alameda Ave Ste 406, 91505‑4813818‑843‑78411/0 (AM PE SP)

CalabasasDC062035 Armen Galustian DDS4764 Park Granada Ste 107, 91302‑3322818‑224‑24201/0 (AM HE RU SP)

43

DeltaCare® USA

DC356501 CALABASAS DENTAL GROUP26500 Agoura Rd Ste 114, 91302‑3558818‑871‑06801/0 (AR AM SP)

CalexicoDC039717 KAMRAN GHOREYSHI FAMILY DENTISTRY408 E 3rd St Ste C, 92231‑2854760‑357‑90001/0 (SP)

CamarilloDC003118 LAS POSAS DENTAL CARE4000 Calle Tecate Ste 111, 93012‑5284805‑383‑67451/0 (12 SP)

DC017291 MISSION OAKS DENTAL GROUP4900 Verdugo Way Ste A, 93012‑8631805‑484‑72774/2

DC018205 R TRENT & GINA TORGERSEN DDS484 Mobil Ave Ste 31, 93010‑6363805‑484‑12212/0 (SP)

DC041958 PALM DENTAL CARE2177 Ventura Blvd, 93010‑7934805‑388‑10480/1 (SP)

DC057498 Raffi Chalian DDS Inc2107 Pickwick Dr, 93010‑6427805‑445‑13331/0 (AM RU SP)

DC198701 CAMARILLO DENTAL GROUP2380 Las Posas Rd Ste A, 93010‑3445805‑388‑91106/0 (SP)

Canoga ParkDC025572 OMEGA DENTAL GROUP21712 Sherman Way, 91303‑1931818‑883‑66341/0 (HE SP)

DC027937 Z. GEORGES RHAYEM D.D.S. DENTAL CORP.21123 Victory Blvd, 91303‑2828818‑888‑27000/1 (AR AM FR SP)

DC037718 101 DENTAL GROUP7259 Owensmouth Ave, 91303‑1530818‑999‑99000/1 (GE SP)

DC058338 St Mark Family Dental Group20913 Sherman Way, 91303‑1743818‑992‑46001/0 (AR SP)

DC061443 Western Dental Services Inc21729 Vanowen St, 91303‑2618818‑898‑085811/0 (SP)

Canyon CntryDC060521 A New Smile Canyon Country27209 Camp Plenty Rd, 91351‑2634661‑251‑04803/0 (FR SP)

Canyon CountryDC031240 SMILES DENTAL GROUP18520 Soledad Canyon Rd Ste G, 91351‑3731661‑252‑28000/1 (AM RU SP)

CarlsbadDC029516 GATEWAY DENTAL GROUP2635 Gateway Rd Ste 101, 92009‑1753760‑431‑81124/2 (SP)

DC030035 GENTLE DENTAL CARLSBAD2620 El Camino Real Ste A, 92008‑1255760‑720‑09665/0 (SP TA)

DC038342 FORUM FAMILY DENTAL1905 Calle Barcelona Ste 229, 92009‑8453760‑753‑67860/1 (SP VI)

DC045527 CARLSBAD FAMILY DENTISTRY2010 Cassia Rd Ste 110, 92009‑4210760‑930‑89001/0 (RU SP)

DC053894 La Costa Dentistry and Orthodontics7625 Via Campanile Ste 130, 92009‑8489760‑633‑16537/0 (SP)

DC057572 CARLSBAD VILLAGE FAIRE DENTISTS DENTAL GROUP300 Carlsbad Village Dr Ste 203, 92008‑2990760‑487‑02034/0

CarsonDC014861 HYACINTH EZEANI DDS460 E Carson Plaza Dr Ste 114, 90746‑3282310‑719‑18651/0

DC016934 ISLAND DENTAL301 W Carson St, 90745‑2608310‑787‑70531/0 (SP)

DC053927 Omid Barkhordar Dental Group101 W Carson St, 90745‑2602310‑513‑02222/0 (RU SP VI)

DC058396 THE DENTAL OFFICE OF CARSON612 E Carson St Ste 101, 90745‑2896310‑469‑93553/0

DC059587 Western Dental Services Inc172 E Carson St, 90745‑2702310‑618‑152220/0 (AM CA CH KO RU SP TA VI)

DC063672 CESAR CARRASCO DDS21847 S Avalon Blvd, 90745‑3304310‑549‑97101/0 (SP)

DC363701 FAMILY DENTAL CENTER22813 Figueroa St, 90745‑4633310‑549‑37171/0 (AR SP)

CastaicDC012356 HASLEY CANYON DENTAL GROUP29655 The Old Rd, 91384‑4570661‑702‑83383/1 (SP)

DC038027 CASTAIC DENTAL CENTER31886 Castaic Rd, 91384‑3946661‑257‑23001/0 (HI PL SP)

Cathedral CityDC050208 WESTERN DENTAL SERVICES INC69160 Ramon Rd Ste 100, 92234‑9140760‑969‑546946/0 (SP)

DC1C3501 PURE DENTAL69420 Ramon Rd, 92234‑3349760‑202‑11712/0 (SP)

CerritosDC013210 PAUL KIM DMD11900 South St Ste 122, 90703‑6800562‑809‑61771/0 (KO PT SP)

DC184301 BLOOMFIELD DENTAL CENTER12657 166th St, 90703‑2101562‑926‑65021/0 (AR SP TA VI)

ChatsworthDC027864 FUTURE DENTAL CARE10242 Canoga Ave, 91311‑3007818‑882‑52520/1 (AR AM FR SP)

DC061248 Chatsworth Dentistry Dental Group10316 Mason Ave, 91311‑3305818‑493‑13023/0 (SP)

DC284101 DEVONSHIRE PLAZA DENTAL GROUP10230 Canoga Ave, 91311‑3007818‑341‑84001/0 (AM FR SP)

ChinoDC026852 CHINO SMILES DENTAL GROUP6961 Schaefer Ave, 91710‑9126909‑590‑06407/2

DC043660 PRIORITY DENTAL GROUP4673 Riverside Dr Ste D, 91710‑5905909‑627‑79771/0

DC047223 BRIGHT NOW DENTAL‑CHINO12027 Central Ave, 91710‑1908909‑270‑429114/0

DC047376 WESTERN DENTAL SERVICES INC12400 Central Ave, 91710‑2603909‑613‑010663/0 (SP)

DC055128 Valdez Family Dentistry4129 Riverside Dr, 91710‑3183909‑591‑92112/0 (SP TA)

DC056744 Chino Valley Smile Center12850 10th St Ste B1, 91710‑4297909‑613‑01111/0 (AR SP)

DC059048 Nguyen Tabari Dental Partnership12604 Central Ave, 91710‑3508909‑591‑17452/0 (AR CA FR JA 12 SP)

DC063040 Delicate Smiles4531 Philadelphia St Ste B107, 91710‑2249909‑902‑91003/0 (CA SP TA)

DC063786 Chino Aesthetic Dental12555 Central Ave Ste B, 91710‑3569909‑627‑09881/0 (HI SP)

Chino HillsDC003117 CHINO HILLS DENTAL GROUP3410 Grand Ave Ste F, 91709‑1473909‑364‑002711/1

44

DeltaCare® USA

DC029176 PINE CENTER DENTAL GROUP5771 Pine Ave Ste S, 91709‑6529909‑597‑24771/0 (KO SP VI)

DC031829 DENTAL CARE OF CHINO HILLS3280 Chino Hills Pkwy Ste 4, 91709‑5866909‑606‑99070/1 (HI SP)

DC062205 Hillcrest Dental Studio2130 Grand Ave Ste H, 91709‑4867909‑927‑53331/0 (HI SP)

DC062598 The Dental Office on Soquel Canyon15850 Soquel Canyon Pkwy Ste A, 91709‑7927909‑375‑01331/0 (SP)

Chula VistaDC009447 TWIN OAKS FAMILY DENTISTRY230 F St Ste D, 91910‑2845619‑427‑52621/0 (FR GE SP)

DC021040 VILLAGE DENTAL GROUP878 Eastlake Pkwy Ste 1511, 91914‑4550619‑739‑49366/1 (HI SP)

DC026776 MEIGS FAMILY DENTAL1040 Tierra Del Rey Ste 209, 91910‑7865619‑656‑97131/0 (SP)

DC030417 CARMEN DENISE MAROON LOPEZ DDS2648 Main St Ste A, 91911‑4664619‑423‑52001/0 (SP TA)

DC031635 SMILE SAN DIEGO585 Telegraph Canyon Rd, 91910‑6436619‑421‑70100/1 (SP TA)

DC034615 CHULA VISTA DENTAL CARE1177 Broadway Ste 19, 91911‑2771619‑409‑14001/1 (SP)

DC040221 SAMUEL HAYATT DMD2260 Otay Lakes Rd Ste 110, 91915‑1007619‑482‑55551/0 (SP)

DC040892 OTAY LAKES DENTAL GROUP2060 Otay Lakes Rd Ste 230, 91913‑1364619‑656‑18651/0 (CH 12 SP TA)

DC044620 CANYON VISTA DENTAL GROUP700 Otay Lakes Rd, 91910‑6912619‑421‑84743/0 (SP)

DC050209 WESTERN DENTAL SERVICES INC1101 Broadway, 91911‑2706619‑422‑889138/0 (SP)

DC056451 Estrada Family Dental Group355 K St Ste A, 91911‑1209619‑934‑57132/0 (SP)

DC057560 Bonita Smiles Dentistry1558 E H St Ste B, 91913‑2018619‑421‑90701/0 (SP)

DC060971 David Gonzalez DDS Dental Corp855 Third Ave Ste 3330, 91911‑1350619‑208‑29081/0 (SP)

DC063287 Eastlake Modern Dentistry Dental Group1690 Millenia Ave Ste 102, 91915‑2889619‑344‑81641/0 (SP)

DC063477 San Ysidro Health Chula Vista678 Third Ave., 91910619‑662‑41001/0 (SP TA)

DC0C1801 GENTLE DENTAL CHULA VISTA520 Broadway Ste 1, 91910‑5376619‑476‑10014/0

City Of IndustryDC005418 VALLEY DENTAL CENTER17595 Almahurst St Ste 101‑2, 91748‑9909626‑965‑74451/0 (SP TA)

DC025605 WALNUT SMILES21750 Valley Blvd Ste C, 91789‑0939909‑595‑08073/1

DC043072 UNIQUE FAMILY COSMETIC DENTISTRY18558 Gale Ave Ste 266, 91748‑1396626‑581‑31881/0 (CH SP)

DC056511 Plaza Dental Group17515 Colima Rd Ste C, 91748‑1859626‑965‑09712/0 (KO SP TA)

ClaremontDC012593 NEWPORT DENTAL406 Auto Center Dr, 91711‑5458909‑624‑61997/0 (SP)

DC046717 WESTERN DENTAL SERVICES INC740 S Hill Blvd Ste B, 91711‑5400909‑625‑609261/0 (KO SP TA)

DC055822 Claremont Modern Dentistry405 W Foothill Blvd Suite 104, 91711‑2786909‑626‑12368/0

ColtonDC063456 Assure Dental1080 E Washington St, 92324909‑783‑90992/0 (SP)

DC368501 ST PATRICK DENTAL CLINIC1200 E Washington St Ste F2, 92324‑6499909‑422‑08850/1 (SP TA TA)

ComptonDC036307 WESTERN DENTAL SERVICES1821 N Long Beach Blvd, 90221‑1203310‑639‑430046/7 (SP)

CorcoranDC063109 United Health Centers of the San Joaquin Valley1209 Whitley Ave, 93212‑2327559‑992‑50202/0 (SP)

CoronaDC001604 JOSEPH RAJABI DDS900 S Main St Ste 107, 92882‑3401951‑734‑41700/1

DC002542 DENTAL R US1303 W 6th St Ste 103, 92882‑3196951‑898‑21012/0 (SP VI)

DC004224 SOUTH CORONA DENTAL GROUP1312 E Ontario Ave Ste 102, 92881‑6645951‑273‑03705/2 (SP)

DC009195 DENTAL ASSOCIATES OF CORONA1380 El Sobrante Rd, 92879‑5759951‑273‑95802/0 (AR HI 4 KO SP TH)

DC010322 BRIGHT NOW DENTAL140 W Ontario Ave Ste 105, 92882‑5272951‑735‑496915/0

DC011789 MCKINLEY DENTAL115 N McKinley St Ste 105, 92879‑6562951‑280‑93001/0 (HI SP)

DC013104 MAIN STREET DENTAL GROUP131 W Ontario Ave Ste 102, 92882‑5274951‑898‑97009/1 (SP)

DC015150 LITA HERMANSJAH DDS916 W 6th St, 92882‑3239951‑738‑17491/0 (IN SP)

DC024304 CORONA FAMILY DENTAL GROUP1358 W 6th St Ste 101, 92882‑3167951‑734‑46200/2 (AR SP)

DC029917 SOFT CARE DENTAL910 Washburn Ave Ste D, 92882‑4383951‑734‑77170/1 (SP TH)

DC032980 GENTLE DENTAL CORONA1074 W 6th St Ste 104, 92882‑1639951‑279‑76501/2

DC052868 Western Dental Services Inc617 N Main St, 92880‑1467951‑273‑387969/0 (SP)

DC059719 Orchard Dental Group2150 California Ave Ste 107, 92881‑7271951‑279‑43331/0 (SP)

DC060185 Mostafa Khattab DDS807 W Grand Blvd Ste B, 92882‑3272951‑737‑87371/0 (AR GE SP)

DC062813 West Corona Dentistry4264 Green River Rd Ste 102, 92880‑1632951‑340‑02001/0 (SP VI)

DC063546 City Dental Centers161 N McKinley St Ste 102, 92879‑6530951‑737‑37461/0

45

DeltaCare® USA

Corona Del MarDC029287 CORONA DEL MAR DENTAL GROUP2345 E Coast Hwy Ste C, 92625‑2034949‑675‑31310/1

CoronadoDC039394 MARTHA MORETT DDS1203 2nd St Ste A, 92118‑1430619‑435‑68401/0 (SP)

Costa MesaDC006360 DAZZLING SMILE DENTAL GROUP204 E 17th St Ste 201, 92627‑7300949‑515‑81811/0 (SP)

DC013168 PACIFIC HARBOR DENTAL GROUP3030 Harbor Blvd Ste G1, 92626‑2562714‑546‑61006/1 (SP)

DC013279 BRIGHT DENTAL CARE320 Bristol St Ste H, 92626‑7946714‑546‑75951/0 (SP VI)

DC022156 NEWPORT DENTAL GROUP1835 Newport Blvd Ste E267, 92627‑5013949‑574‑01000/1 (IT RU SP TR)

DC033581 BRIGHT NOW DENTAL COSTA MESA2300 Harbor Blvd Ste H5, 92626‑6203949‑610‑014610/2 (AR KO VI)

DC036332 WESTERN DENTAL SERVICES534 W 19th St, 92627‑2748949‑645‑140836/9 (SP)

DC045295 NEWPORT SMILES DENTAL SPA570 W 19th St, 92627‑2749949‑642‑10331/0 (PT SP)

DC055690 Smile Max Dental2969 Harbor Blvd, 92626‑3912714‑437‑11001/0 (SP TR)

DC057753 SOCAL SMILES DENTISTRY230 E 17th St Ste 208, 92627‑3898949‑645‑00451/0 (KO SP TA VI)

DC061281 Brite Clean Smiles488 E 17th St Ste A101, 92627‑3277949‑777‑10051/0 (SP)

DC061405 17TH Street Modern Dentistry Dental Group270 E 17th St Ste 15, 92627‑3845714‑224‑04802/0 (SP)

CovinaDC015597 AHMED SAEED DDS INC661 S 2nd Ave, 91723‑3518626‑966‑35710/1 (SP)

DC032182 COLLEGE STREET FAMILY DENTAL GROUP153 W College St, 91723‑2008626‑339‑90850/1 (KO SP)

DC039353 COVINA DENTAL ARTS & ORTHODONTICS558 W Badillo St, 91722‑3762626‑331‑05065/1 (AM FR KO SP TA TR VI)

DC057366 Your Covina Family Dentistry675 S 2nd Ave, 91723‑3518626‑966‑31081/0 (AR RU SP)

DC058810 Wong Dental Corporation626 S 2nd Ave, 91723‑3517626‑332‑00131/0 (AR CA CH 12 PE RU SP TA VI)

DC058966 Sylvia Salem DDS Inc650 S 1st Ave, 91723‑3538626‑332‑73111/0 (AR SP)

DC061109 Covina Family & Cosmetic Dentistry Inc4708 N Grand Ave, 91724‑2005626‑332‑86081/0 (SP TA)

DC061703 Western Dental Services Inc1453 N Azusa Ave Ste F4, 91722‑1201626‑330‑289424/0 (SP)

DC0C5901 COVINA DENTAL OFFICE1052 N Citrus Ave, 91722‑2739626‑967‑67671/0 (AR SP)

CudahyDC025191 ST JAMES DENTAL GROUP7607 Atlantic Ave, 90201‑5019323‑771‑72541/0 (SP)

DC063205 Western Dental Services Inc7903 Atlantic Ave Ste G, 90201‑5926323‑773‑22005/0 (SP)

Culver CityDC005952 ALL CARE DENTAL4310 Overland Ave, 90230‑4117310‑837‑80871/0

DC013514 CULVER CITY FAMILY DENTISTRY4909 Sepulveda Blvd, 90230‑5264310‑313‑31001/0 (SP)

DC053860 Smile Comfort Dental9702 Venice Blvd Ste A, 90232‑2717310‑895‑98851/0 (AR AM CH 12 RU SP TA)

CypressDC015308 CYPRESS DENTAL GROUP9922 Walker St Ste C, 90630‑3097714‑220‑03541/0 (HE SP)

DC044443 FAMILY DENTISTRY GAMAL TEWFIK6334 Lincoln Avenue, 90630‑5811714‑527‑18010/1 (AR SP)

DC062221 Cypress Modern Smiles6897 Katella Ave, 90630‑5107714‑952‑30441/0 (SP VI)

Dana PointDC019004 DANA POINT DENTAL GROUP34080 Golden Lantern St Ste 201, 92629‑2679949‑661‑56640/2 (KO SP)

Del MarDC007272 DEL MAR PROFESSIONAL DENTAL GROUP13983 Mango Dr Ste 106, 92014‑3146858‑792‑66620/1

DC036821 DELMAR DENTISTRY CENTER318 9th St Ste C, 92014‑2805858‑259‑91291/0 (TR)

DC059759 Promenade Dentistry Dental Group2710 Via De La Valle Ste B250, 92014‑1931858‑703‑10121/0 (SP)

DelanoDC013857 LETICIA TOLENTINO DMD INC1625 Cecil Ave # A, 93215‑1515661‑725‑93931/0 (13 SP TA)

DC049580 WESTERN DENTAL SERVICES730 Woollomes Ave Ste 101, 93215‑9506866‑415‑195831/0 (SP)

Diamond BarDC035451 DIAMOND BAR SMILES2841 S Diamond Bar Blvd Ste B, 91765‑3473909‑860‑62325/1 (SP)

DC042787 DIAMOND DENTAL GROUP DIAMOND BAR20657 Golden Springs Dr Ste 207, 91789‑3898909‑595‑82880/2 (AR CH SP)

DC047663 RITCHIE PARK DDS INC1155 S Diamond Bar Blvd Ste B, 91765‑2235909‑396‑44351/0

DC198101 GRAND AVENUE DENTISTRY1111 Grand Ave Ste G, 91765‑2227909‑860‑58540/1 (HI KO SP)

DowneyDC000646 PLANET DENTAL8843 Rosecrans Ave Ste A, 90242‑5286562‑633‑93002/0 (KO SP TA)

DC023299 MEHREGAN DENTAL CORPORATION10558 Paramount Blvd, 90241‑2405562‑869‑20912/0 (SP)

DC033113 KENNETH W CHENG DDS8029 Imperial Hwy, 90242‑3713562‑862‑69790/1 (KO 12 SP)

DC034386 FARNAZ HAYAVI DDS8301 Imperial Hwy, 90242‑3830562‑862‑57771/0 (AM KO SP VI)

DC044946 DR. ZAK DOWNEY DENTAL CARE10501 Lakewood Blvd Ste A‑B, 90241‑2709562‑862‑234110/2 (RO SP)

46

DeltaCare® USA

DC046676 WESTERN DENTAL SERVICES INC9906 Imperial Hwy, 90242‑3207562‑940‑646368/0 (CH HI 12 PE SP)

DC056608 Downey Promenade Dental Group8998 Apollo Way, 90242‑4030562‑441‑72127/0

DC059037 Downey Dental Center8515 Florence Ave Ste 200, 90240‑4043562‑869‑45323/0 (CA CH SP)

DC059057 Bright Now! Dental‑Downey8612 Firestone Blvd, 90241‑5243562‑382‑152811/0 (SP)

DC059291 Downey Dental Arts8077 Florence Ave Ste 107, 90240‑3981562‑928‑69001/0 (SP)

DC062393 The Downey Dentist7825 Florence Ave Ste B, 90240‑3976562‑746‑03501/0 (SP)

DC062476 All Kids Dental Care9474 Firestone Blvd, 90241‑5504562‑803‑422410/0 (AR AM CA CH KO 12 RU SP)

DuarteDC039750 DUARTE FAMILY DENTAL1217 Buena Vista St Ste 202, 91010‑2413626‑357‑22541/0 (PE SP)

EarlimartDC063123 United Health Centers of the San Joaquin Valley476 E Washington, 93219661‑849‑27812/0 (SP)

EastvaleDC011174 GATEWAY DENTAL GROUP & ORTHODONTICS12571 Limonite Ave Ste 230, 91752‑3677951‑360‑34444/1 (SP)

DC011787 BRIGHT NOW! DENTAL12636 Limonite Ave Ste 1A and 1B, 92880‑4200951‑808‑432320/1

DC060993 Eastvale Smiles Dentistry13334 Limonite Ave Ste 120, 92880951‑228‑92942/0 (SP)

El CajonDC029203 EL CAJON FAMILY DENTAL2720 Fletcher Pkwy, 92020‑2110619‑466‑12921/0 (AR SP)

DC036104 RSD DENTAL GROUP AND ORTHODONTICS2907 Jamacha Rd Ste B, 92019‑4342619‑660‑24244/2 (SP)

DC038229 BRIGHT NOW! DENTAL RANCHO2502 Jamacha Rd, 92019‑4364619‑212‑795911/0

DC043648 DENTAL ARTS GROUP707 Arnele Ave, 92020‑2501619‑444‑10011/0 (JA RU SP TA)

DC046647 WESTERN DENTAL SERVICES INC583 N 2nd St, 92021‑6449619‑440‑622237/0 (SP)

DC050225 LIFE SMILES DENTAL CARE1530 Hilton Head Rd Ste 111, 92019‑4655619‑441‑80001/0 (AR SP)

DC062403 Steele Canyon Smiles and Orthodontics2990 Jamacha Rd Ste 132, 92019‑4320619‑670‑17005/0

DC062738 CitiDental Rancho2451 Jamacha Rd Ste 104, 92019‑4324619‑444‑05002/0 (AR)

DC062882 SmilePlus Dentistry‑El Cajon1242 East Main St., 92021619‑444‑63553/0 (AR SP)

DC063807 Brenda Evans Louka DDS Inc APC1276 E Washington Ave, 92019‑3036619‑440‑92111/0 (AR SP)

El CentroDC036308 WESTERN DENTAL SERVICES1450 N Imperial Ave, 92243‑1314760‑370‑395022/9 (HI)

DC063682 El Centro Dental852 E Danenberg Dr, 92243‑8511760‑344‑99512/0 (SP)

El MonteDC002096 EASTERN LOS ANGELES DENTAL12015 Garvey Ave Ste A, 91732‑3156626‑454‑18881/0 (CH SP)

DC003785 CENTRAL DENTAL GROUP12072 Valley Blvd, 91732‑3137626‑527‑22000/1 (CA CH 12 SP VI)

DC012851 ALFONSO MARTINEZ DDS11733 Valley Blvd, 91732‑3073626‑575‑75651/0 (SP)

DC019551 SUNSHINE DENTAL GROUP4161 Tyler Ave, 91731‑1966626‑579‑42741/0 (SP)

DC020419 SWE DENTISTRY10354 Garvey Ave Ste B, 91733‑2133626‑350‑83660/1 (SP)

DC022740 DR BERI DENTAL OFFICE10496 Garvey Ave, 91733‑2265626‑442‑56780/1 (HI SP)

DC053109 Western Dental Services Inc11450 Valley Blvd, 91731‑3230626‑532‑144249/0 (SP)

DC059553 COMFORT DENTAL GROUP10012 Garvey Ave Ste 11, 91733‑2086626‑433‑13002/0 (AM SP)

DC061600 626 Dental Care4900 Peck Rd, 91732‑1422626‑579‑51581/0 (CA CH 12 SP)

DC062051 Atlantic Pacific Smile Group of El Monte11230 Garvey Ave Ste H, 91733‑2475626‑401‑12352/0 (CH 12 SP)

DC063264 Serenity Dental10811 Garvey Ave, 91733‑2301626‑442‑61151/0 (SP TR)

El SegundoDC059937 El Segundo Modern Dentistry & Orthodontics310 E Grand Ave Ste 102, 90245‑3871424‑277‑11381/0 (SP)

EncinitasDC014605 CAMINO DENTAL GROUP1340 Encinitas Blvd Ste 100, 92024‑2844760‑942‑39003/3 (SP)

DC034728 NCH DENTAL477 N El Camino Real Ste C210, 92024‑1355760‑943‑88801/0 (KO SP)

DC054308 Encinitas Dental Wellness285 N El Camino Real Ste 216, 92024‑5385760‑753‑12271/0

DC057607 Encinitas Smiles Dentistry Dental Group415 Santa Fe Dr, 92024‑5134760‑388‑21614/0

EncinoDC017619 MOSHE ABRAMOVICI DDS16550 Ventura Blvd Ste 403, 91436‑5025818‑986‑08980/0 (HE RO RU)

DC019961 ENCINO DENTAL ESTHETICS17525 Ventura Blvd Ste 100, 91316‑5100818‑784‑78321/0 (SP)

DC023865 ENCINO COSMETIC DENTAL GROUP16133 Ventura Blvd Ste 1100, 91436‑2415818‑906‑22221/0 (SP)

DC032956 DANIEL TEBBI DMD16661 Ventura Blvd Ste 620, 91436‑4812818‑789‑20341/0 (SP)

DC053505 Encino Smile Care15720 Ventura Blvd Ste 300, 91436‑2922818‑788‑66841/0

DC058024 Encino Family Dental Group15720 Ventura Blvd Ste 322, 91436‑2993818‑788‑70601/0 (FR RU SP)

47

DeltaCare® USA

DC059728 PARTOVY PROFESSIONAL DENTAL GROUP16055 Ventura Blvd Ste 400, 91436‑2608818‑990‑04001/0 (AM RU SP)

DC061700 All About Smile Dental Group16133 Ventura Blvd Ste 1120, 91436‑2415818‑788‑06512/0 (FR SP TA VI)

DC164601 DAN ROSEN DDS16542 Ventura Blvd Ste 505, 91436‑4576818‑907‑67361/0

DC179901 RENE GHOTANIAN DDS5363 Balboa Blvd Ste 346, 91316‑2836818‑990‑35511/0 (AM SP)

DC184401 ENCINO DENTAL CENTER17815 Ventura Blvd Ste 101, 91316‑3637818‑708‑12001/0 (HE SP)

EscondidoDC005132 GENTLE DENTAL‑DEL LAGO3440 Del Lago Blvd Ste C, 92029‑7430760‑746‑87771/0 (GE SP)

DC007041 ESCONDIDO DENTAL GROUP403 W Felicita Ave, 92025‑6517760‑233‑22600/1 (SP)

DC034863 BRIGHT NOW DENTAL ESCONDIDO1286B Auto Park Way, 92029‑2232760‑705‑946419/0

DC036286 WESTERN DENTAL SERVICES1468 E Valley Pkwy, 92027‑2314760‑480‑870037/9 (AR RU SP)

DC036836 BRIGHT NOW DENTAL501 W Felicita Ave Ste 101, 92025‑5639760‑705‑315016/0

DC040743 ESCONDIDO SMILES DENTAL GROUP860 W Valley Pkwy Ste 100, 92025‑2534760‑745‑15853/1 (SP)

DC045918 MAPLE STREET DENTAL GROUP327 S Maple St, 92025‑4122760‑745‑25501/0 (SP)

DC055994 NC Dental Specialties1356 W Valley Pkwy Ste K, 92029‑2138760‑233‑58871/0

DC056975 Leilani S Alarcon DDS Inc925 E Pennsylvania Ave Ste D, 92025‑3432760‑747‑31401/0 (SP TA)

DC060116 NC Family Dental1018 W El Norte Pkwy, 92026‑3341760‑740‑25951/0 (SP)

DC063170 Escondido Valley Braces913 E Valley Pkwy, 92025‑3428760‑233‑23331/0 (SP)

DC063960 Escondido Dental Arts202 S Juniper St, 92025‑4221706‑306‑44662/0 (PE RU SP)

DC154801 EL NORTE FAMILY DENTAL306 W El Norte Pkwy Ste D, 92026‑1960760‑480‑56000/1 (HI JA SP)

DC191801 FAMILY CARE DENTAL1114 W Valley Pkwy, 92025‑2559760‑738‑10700/1 (SP TA VI)

DC196901 VILLAGE DENTAL CENTER8895 Lawrence Welk Dr, 92026‑6407760‑749‑75001/0 (SP)

FontanaDC007661 DR VORAS GATEWAY DENTAL OFFICE15032 Summit Ave Ste 410, 92336‑5393909‑899‑39401/0 (HI SP)

DC014116 TRIANGLE DENTAL GROUP14305 Baseline Ave, 92336‑3631909‑355‑17005/2 (SP)

DC015612 VAHAN GRIGORYAN DDS7993 Sierra Ave Ste D, 92336‑3330909‑428‑51111/0 (AM RU SP TA)

DC017952 BRIGHT NOW! DENTAL16135 Sierra Lakes Pkwy Ste 200, 92336‑1253909‑356‑200623/1 (SP)

DC021056 SIERRA LAKES DENTAL GROUP16475 Sierra Lakes Pkwy Ste 140, 92336‑1259909‑357‑08699/1 (SP)

DC030621 GUPTAS’S DENTAL GROUP16049 Baseline Ave Unt 3, 92336‑1830909‑356‑97522/0 (HI SP)

DC033532 SIERRA PARKWAY DENTAL CARE16953 Sierra Lakes Pkwy Ste 110, 92336‑1272909‑357‑39000/1 (HI SP)

DC058478 Western Dental Center10144 Sierra Ave, 92335‑6725909‑428‑050078/0 (FR PE SP)

DC059020 Young Kwun Kim DDS Inc8110 Mango Ave Ste 101, 92335‑3603909‑829‑93241/0 (KO SP)

DC062273 Sierra Dental Health9190 Sierra Ave Ste 101, 92335‑8613909‑356‑42001/0 (SP VI)

DC062789 Dentists of Fontana Dental Group16944 S Highland Ave Ste 400, 92336‑3464909‑275‑71792/0 (SP)

DC325201 GUPTA DENTAL CORPORATION11623 Cherry Ave Ste B2, 92337‑1212909‑355‑14851/0 (HI PE SP)

Foothill RanchDC019421 TOWNE CENTRE DENTAL GROUP45 Auto Center Dr Ste 110, 92610‑2848949‑588‑59062/2 (HI SP)

Fountain ValleyDC036364 BRIGHT NOW DENTAL18633 Brookhurst St, 92708‑6748714‑274‑422213/1

DC058403 Fountain Valley Dental Esthetics17900 Brookhurst St Ste A, 92708‑5141714‑887‑43372/0 (SP VI)

DC060004 Dental Arts11703 Edinger Ave, 92708‑1208714‑775‑19341/0 (CH SP VI)

DC060643 Andreea Moisiuc DDS Inc17037 Brookhurst St Ste 4, 92708‑3623714‑962‑23001/0 (RO SP VI)

DC061998 Medical Center Dental Group11160 Warner Ave Ste 303, 92708‑4055714‑557‑84921/0

Fountain VlyDC002516 DAVID COHEN DDS11180 Warner Ave Ste 451, 92708‑7505714‑444‑44281/0 (SP)

DC384201 QUALITY DENTAL CARE17150 Euclid St Ste 322, 92708‑4092714‑444‑42241/0 (AR SP)

FullertonDC003989 NEWPORT DENTAL1718 W Orangethorpe Ave, 92833‑4538714‑525‑385511/0 (SP)

DC004716 US DENTAL GROUP1441 Brea Blvd, 92835‑3507714‑992‑03001/0 (AR AM PE SP)

DC010101 FULLERTON DENTAL CENTER446 E Commonwealth Ave, 92832‑2019714‑680‑67671/1 (KO SP)

DC015258 SUNSHINE DENTAL506 W Commonwealth Ave, 92832‑1723714‑738‑77771/0 (SP)

DC033363 FULLERTON FAMILY DENTAL906 W Orangethorpe Ave, 92832‑2827714‑871‑39003/0 (AR CA FinnishFR GE KO 12 SP TA)

DC043707 FULLERTON DENTAL ART717 N Placentia Ave, 92831‑3289714‑577‑01050/1 (HI SP)

48

DeltaCare® USA

DC047625 FULLERTON DENTAL GROUP1573 S Harbor Blvd, 92832‑3402714‑441‑01315/0 (SP)

DC056743 Eric C Chiang DDS100 N State College Blvd Ste E, 92831‑4236714‑738‑84521/0 (12 SP)

DC058520 Western Dental‑Fullerton1620 S Harbor Blvd Ste A, 92832714‑294‑706646/0 (SP)

DC063381 Selenite Dental508 S Harbor Blvd, 92832‑2411714‑770‑04551/0 (AR SP)

DC183601 NANDINI MURTHY DDS607 E Chapman Ave, 92831‑3803714‑774‑26380/1

Garden GroveDC011701 CENTURY DENTAL CARE13011 Century Blvd, 92843‑1209714‑534‑70201/0 (KO SP VI)

DC055976 Peach Dental12462 Brookhurst St Ste C, 92840‑4759714‑638‑74701/0 (AR FR KO SP TA VI)

DC056098 Garden Grove Dental Care12630 Brookhurst St Ste B, 92840‑4886714‑530‑49201/0 (AR HE SP VI)

DC059432 Western Dental Services Inc12141 Garden Grove Blvd, 92843‑1628714‑530‑980123/0

DC061969 My OC Dental Care13732 Euclid St, 92843‑3419714‑530‑09211/0 (CH SP)

DC062097 Joeun Dental Group9872 Chapman Ave Ste 102, 92841‑2718714‑539‑89473/0 (KO SP)

DC062247 Coastal Dental Care10044 Westminster Ave, 92843‑4721714‑539‑70702/0 (CH SP VI)

GardenaDC001813 CITY DENTAL CENTER1300 W 155th St Ste 208, 90247‑4061310‑715‑27230/1 (SP)

DC057457 Gardena Dental Care1600 W Redondo Beach Blvd Ste 203, 90247‑3228310‑808‑01981/0 (SP)

DC063926 Western Dental Services Inc15515 S Normandie Ave, 90247‑4013310‑953‑09005/0

DC173301 PLAZA DENTAL14240 S Vermont Ave, 90247‑2208310‑515‑55111/0 (SP)

GlendaleDC001666 ALENOUSH BAGDASARYAN DDS457 Palm Dr Ste 100, 91202‑3221818‑956‑37331/0 (AM FR PE)

DC003132 ARTEMIS SARADJIAN DDS205 S Verdugo Rd # A, 91205‑1424818‑244‑49492/0 (AR AM SP)

DC012933 CARMEN OHANIAN DDS1110 N Brand Blvd Ste 201, 91202‑2567818‑244‑02151/0 (AM RU)

DC013449 TOWN CENTER DENTISTRY316 E Broadway Ste A, 91205‑1011818‑548‑77001/0 (AM CA CH 12 RU SP)

DC023481 GLENDALE PREMIER DTL CENTER819 N Pacific Ave, 91203‑1027818‑240‑17601/1 (AR AM HE RU SP)

DC028405 STARLIGHT DENTAL GROUP207 N Central Ave, 91203‑2510818‑243‑88881/0 (AM SP)

DC035753 IRINA M SAHAKI DDS520 E Broadway Ste 402, 91205‑4912818‑241‑24241/0 (AM KM FR PE RU)

DC053763 Armen Manssourian DMD1122 N Brand Blvd Ste 102, 91202‑2570818‑242‑26672/0 (AM SP)

DC058594 Comfort Care Glendale1134 N Brand Blvd, 91202‑2504818‑246‑22532/0 (AM SP)

DC060192 Verdugo Hills Dental Group3600 N Verdugo Rd Ste 302, 91208‑1258818‑839‑74751/0 (AM SP)

DC062582 Dentists of Glendale Dental Group3900 San Fernando Rd Ste 1017A, 91204‑2858818‑528‑48442/0 (SP)

DC063843 Broadway Dental727 E Broadway, 91205‑1103818‑240‑58882/0 (CH SP)

DC235901 JOHN YEKIKIAN DDS1128 N Brand Blvd, 91202‑2504818‑242‑47031/0 (AM FR PE SP)

GlendoraDC013849 SHAWKY SOLIMAN DDS INC150 S Grand Ave Ste F, 91741‑4720626‑914‑31501/0 (AR SP)

DC016959 WOODGLEN DENTAL CENTER220 S Glendora Ave Ste B, 91741‑3439626‑914‑40540/1 (AR SP)

DC021055 GLENDORA SMILES DENTISTRY AND ORTHODONTICS DENTAL605 W Route 66, 91740‑4122626‑771‑13207/1 (AR AM KO 12 SP)

DC036537 NEW VISION DENTAL1814 E Route 66 Ste B, 91740‑3869626‑963‑70001/0 (SP VI)

DC043851 FOOTHILL FAMILY DENTAL GROUP210 S Grand Ave Ste 420, 91741‑4294626‑963‑33222/0 (AR AM FR PE SP)

DC054957 Glendora Dental Arts1343 E Gladstone St Ste 204, 91740‑6717909‑592‑14321/0

DC055400 Advanced Dental Smiles455 W Foothill Blvd, 91741‑3363626‑914‑98081/0 (CH SP VI)

DC061110 Downtown Dental1435 E Route 66 Ste D, 91740‑3748626‑914‑39001/0 (AR AM SP)

DC061718 Glendora Dental Center610 E Route 66, 91740‑3507626‑335‑77273/0 (AR FR GE SP TA TA)

GoletaDC041299 WESTERN DENTAL SERVICES5680 Calle Real, 93117‑2317805‑979‑315522/1 (SP)

DC061833 Johnson Family Dental‑Goleta7050 Hollister Ave Ste 101, 93117‑2811805‑695‑338815/0 (SP)

Granada HillsDC020519 BALBOA DENTAL GROUP11850 1/2 Balboa Blvd, 91344‑2753818‑360‑19469/1

DC038230 MISSION HILLS DENTAL10515 Balboa Blvd Ste 250, 91344‑6361818‑365‑86001/0 (SP)

DC039080 KAMRAN RAFIE DDS17656 Chatsworth St, 91344‑5601818‑363‑02001/1 (SP)

DC043477 BRIGHT NOW DENTAL18121 Chatsworth St, 91344‑5610818‑491‑005620/0 (PE SP)

DC054785 Granada Hills Family Dental16917 Devonshire St, 91344818‑360‑09571/0 (RU SP)

DC320001 JOHN BOSAK DMD10727 White Oak Ave Ste 213, 91344‑4656818‑368‑56761/0 (SP)

Hacienda HtsDC023805 TRI‑CITY SMILES DENTISTRY AND ORTHODONTICS17188 Colima Rd Ste B, 91745‑6787626‑581‑78783/1 (SP)

49

DeltaCare® USA

HanfordDC036358 WESTERN DENTAL SERVICES1560 Lacey Blvd # 107, 93230‑9305559‑589‑630229/8 (SP)

DC036586 WESTERN DENTAL SERVICES210 N 11th Ave Ste 101, 93230‑4591559‑585‑217032/9 (SP)

Harbor CityDC2C9101 BAY HARBOR DENTAL OFFICE1537 Lomita Blvd, 90710‑2024310‑530‑52521/0 (SP)

Hawaiian GdnsDC013434 NEWPORT DENTAL‑HAWAIIAN GARDENS21714 Pioneer Blvd, 90716‑1236562‑421‑373715/1 (SP)

HawthorneDC003889 SANTA MARIA DENTAL OFFICE11938 Hawthorne Blvd, 90250‑3016310‑973‑09451/0 (SP)

DC015649 CASTLE DENTAL CENTERS13220 Hawthorne Blvd, 90250‑5804310‑679‑901917/0

DC030248 ALL KIDS DENTAL CARE13340 Hawthorne Blvd, 90250‑5805310‑973‑80041/0

DC055903 Blue Dental Group12923 Inglewood Ave Ste 3, 90250‑5139310‑263‑10303/0 (AR AM HI KO PE RU SP TA TR VI)

DC057949 Western Dental Services Inc14248 Hawthorne Blvd, 90250‑7008310‑978‑297351/0

HemetDC012150 HEMET DENTAL GROUP AND ORTHODONTICS4000 W Florida Ave, 92545‑5279951‑658‑99808/2 (SP)

DC016801 BRIGHT NOW! DENTAL2721 W Florida Ave, 92545‑4616951‑925‑222615/2 (SP TA VI)

DC036130 BRIGHT SMILE DENTISTRY1020 E Florida Ave, 92543‑4511951‑765‑12340/1 (AR SP)

DC046075 HEMET SMILES1001 S State St Ste B, 92543‑7188951‑658‑61001/0 (SP)

DC047375 WESTERN DENTAL SERVICES INC2091 W Florida Ave Ste 100, 92545‑4800951‑929‑058265/0 (SP)

DC059686 West Coast Dental Group of Hemet3027 W Florida Ave P1, 92545‑3617951‑791‑91117/0 (AR AM CA KO PE PT SP)

DC061691 Bravo Dental of Hemet1300 E Florida Ave # A20, 92544‑8640951‑765‑55441/0 (AR SP)

DC062533 Hemet Modern Dentistry Dental Group1115 S Sanderson Ave, 92545‑9047951‑404‑53071/0 (SP)

Hermosa BeachDC046274 HERMOSA SMILES DENTISTRY1559 Pacific Coast Hwy Ste 101, 90254‑3214310‑372‑76869/0

HesperiaDC013688 GENTLE DENTAL16455 Main St Ste 17, 92345‑3505760‑244‑60772/0

DC018517 BRIGHT NOW DENTAL17003 Bear Valley Rd Ste D, 92345‑1420760‑244‑190013/0

DC026917 HIGH DESERT SMILES DENTISTRY12821 Main St Ste 150, 92345‑9130760‑947‑98536/2

DC043394 RADIANT DENTAL15398 Main St Ste A, 92345‑3391760‑949‑72111/0 (SP)

DC058268 Eagle Dental12052 Hesperia Rd Ste 4, 92345‑1808844‑563‑24531/0 (CH SP)

DC062354 Desert Dentist14661 Main St, 92345‑3308760‑244‑50473/0 (KO SP)

DC063514 Western Dental Services Inc13368 MAIN ST STE 300, 92345‑4730760‑810‑41188/0 (SP)

DC391001 DESERT VALLEY DENTAL GROUP16868 Main St, 92345‑6030760‑244‑26258/0 (SP)

HighlandDC016135 INLAND DENTAL CENTER HIGHLAND6982 Boulder Ave, 92346‑3328909‑862‑21211/1 (SP)

DC027405 HIGHLAND DENTAL GROUP AND ORTHODONTICS27949 Greenspot Rd Ste H, 92346‑4444909‑864‑60106/3 (SP)

HollywoodDC175401 SAMI NOUHAD DDS7080 Hollywood Blvd Ste 817, 90028‑6935323‑466‑35411/0 (AR SP)

Huntington BeachDC000185 LINA MUSLEH DDS19754 Beach Blvd, 92648‑2989714‑964‑88301/0 (SP)

DC003093 BEACH DENTAL GROUP19720 Beach Blvd Ste A, 92648‑2987714‑593‑10106/1 (SP)

DC011891 PEARLY WHITE DENTAL16474 Bolsa Chica St, 92649‑2603714‑377‑37361/0 (AR AM CH FR PL SP TA VI)

DC015581 HARBOUR LANDING DENTAL4911 Warner Ave Ste 202, 92649‑4473714‑846‑44140/1 (AR KO 12 SP)

DC029634 COSMETIC & DENTAL IMPLANT CENTER19080 Brookhurst St, 92646‑2552714‑968‑25270/1 (SP VI)

DC030941 BIG DENTAL GROUP18682 Beach Blvd Ste 100, 92648‑2049714‑968‑35221/1 (AR SP TR VI)

DC042025 HUNTINGTON BEACH DENTAL OFFICE15047 Goldenwest St, 92647‑2710714‑898‑44251/0

DC047468 SUBODH SWAROOP DDS INC9952 Hamilton Ave, 92646‑8016714‑593‑02562/0 (SP)

DC052189 Hunting Beach Modern Dentistry16071 Goldenwest St, 92647714‑536‑23839/0 (SP)

DC054114 Celine T. Pham19059 Bushard St, 92646‑2431714‑964‑20401/0 (SP VI)

DC055328 Allure Dental Specialist18593 Beach Blvd Ste B, 92648‑2053714‑581‑89891/0 (IT SP TA TA VI)

DC059015 Noleen Nguyen DDS Inc16903 Beach Blvd, 92647‑4808714‑375‑00441/0 (SP VI)

DC060733 Safari Dental & Implants16511 Goldenwest St Ste 101, 92647‑4484714‑848‑92001/0 (GE SP)

DC062583 HB Kids Dentistry Dental Group9842 Adams Ave Ste 101, 92646‑4827714‑823‑38301/0 (SP)

DC062629 Seascape Cosmetic and Implant Dentistry18632 Beach Blvd Ste 115, 92648‑2047714‑636‑97002/0 (SP)

DC063542 Dental Associates of Huntington Beach5942 Edinger Ave Ste 101, 92649‑1774714‑377‑44491/0 (SP)

50

DeltaCare® USA

Cardinal Dental19365 Main St Ste 108, 92648‑2483949‑393‑29991/0 (AM 14)

DC200701 BEACHSIDE DENTAL GROUP18800 Main St Ste 110, 92648‑1717714‑842‑61512/1 (AR CH FR HE HI 12 RU SP TA VI)

Huntington ParkDC002376 HUNTINGTON PARK FAMILY DENTAL2711 E Slauson Ave, 90255‑3002323‑582‑44741/0 (AR AM CH SP)

DC052410 Hamid Imankhan DDS Inc2634 Clarendon Ave, 90255‑4120323‑585‑27772/0 (FR SP)

DC058823 HP Dental Group5802 Pacific Blvd, 90255‑2618323‑583‑16443/0 (KO SP)

DC060133 Smiles West Dental and Braces of Huntington Park5501 Pacific Blvd, 90255‑2534323‑586‑06007/0 (AR AM CH FR JA KO 12 PE PL SP TA TH VI)

DC060946 Total Care Dental and Orthodontics2630 Zoe Ave, 90255‑4132323‑230‑63663/0 (AR AM CH FR HI KO PL RU SP)

DC062485 Mi Sonrisa Dental Group7208 Pacific Blvd Ste 200, 90255‑5770323‑582‑22001/0 (SP)

DC270201 KIMS FAMILY DENTISTRY7601 Seville Ave, 90255‑6029323‑587‑66001/0 (KO SP)

Huntington PkDC053100 Western Dental Services2630 E Gage Ave, 90255‑4122323‑587‑178845/0 (SP)

HuronDC063113 United Health Centers of the San Joaquin Valley16928 11th St, 93234559‑945‑25411/0 (SP TA)

ImperialDC185301 SUN DENTAL OFFICE OF DR CERVANTES2387 US Highway 86, 92251‑9780760‑353‑51001/0 (SP)

Imperial BeachDC024542 IMPERIAL BEACH DENTAL GROUP1340 Imperial Beach Blvd Ste 201, 91932‑3046619‑429‑66001/0 (SP)

IndioDC017293 GENTLE DENTAL INDIO81557 Doctor Carreon Blvd Ste D3, 92201‑5563760‑998‑15691/2 (AR CS SP)

DC017508 MATT T JAM DDS81730 US Highway 111 Ste 8, 92201‑5441760‑347‑75051/0 (SP)

DC021202 INLAND DENTAL CENTER44100 Jefferson St Ste D404, 92201‑2714760‑772‑02147/0 (AR SP VI)

DC023264 TOWN & COUNTRY DENTAL81637 US Highway 111 Ste 1, 92201‑5439760‑342‑14480/1 (SP)

DC050205 BRIGHT NOW! DENTAL ‑ INDIO42250 Jackson St Ste 102, 92203‑9783760‑238‑40119/0

DC050207 WESTERN DENTAL SERVICES INC81735 US Highway 111 Ste A, 92201‑0715760‑391‑446646/0 (SP)

DC061661 Indio Modern Dentistry Dental Group82151 Avenue 42 Ste 110, 92203760‑255‑75972/0 (SP)

DC062098 Pacific Wave Dental45841 Oasis St Ste 3, 92201‑4505760‑289‑71161/0 (SP)

InglewoodDC021677 LAX DENTAL GROUP4201 W Century Blvd, 90304‑1617310‑981‑90002/0 (SP)

DC029202 EMMANUEL N OKONKWO DDS2710 W Manchester Blvd Ste 3, 90305‑2436323‑971‑50251/0 (IboSP)

DC041271 NEWHART DENTAL INC3516 W Imperial Hwy, 90303‑2222310‑677‑91013/1 (SP)

DC045739 INGLEWOOD FAMILY DENTISTRY327 W Manchester Blvd, 90301‑1107310‑491‑28721/0 (SP)

DC057955 Western Dental Center3561 W Centruy Blvd Ste D, 90303323‑483‑704132/0 (SP)

DC062261 Crown Dental1295 S La Brea Ave Ste 101, 90301‑0972310‑672‑01291/0 (SP)

IrvineDC000596 MALEK MANSOUR DDS22 Odyssey Ste 265, 92618‑7701949‑585‑15152/0 (AR FR)

DC000757 DR AMIR SADJADI DMD PC4950 Barranca Pkwy Ste 304, 92604‑4631949‑861‑84411/0 (CH FR LO PE SP)

DC002410 ART OF DENTISTRY INSTITUTE2646 Dupont Dr Ste 200, 92612‑1689949‑955‑33661/0 (HI IT SP)

DC002461 ROYA TOOMARIAN DDS16520 Bake Pkwy Ste 155, 92618‑4694949‑786‑06401/0

DC013086 DENTAL CARE OF IRVINE4330 Barranca Pkwy Ste 230, 92604‑4756949‑786‑12341/0 (KO SP)

DC017914 GENTLE DENTAL4950 Barranca Pkwy Ste 105, 92604‑4630949‑551‑42425/0 (CA HI 12 SP VI)

DC019892 OC DENTAL GROUP14130 Culver Dr Ste C, 92604‑0321949‑653‑88880/1 (AR FR 12 SP TA)

DC034743 IRVINE SMILE ARTS DENTISTRY14150 Culver Dr Ste 204, 92604‑0322949‑726‑10011/0 (HI)

DC034769 UNIVERSITY PARK DENTAL5321 University Dr Ste A, 92612‑2942949‑653‑22441/0 (FR SP)

DC040898 WALNUT DENTAL GROUP & ORTHODONTICS14415 Culver Dr, 92604‑0305949‑733‑04865/1 (SP)

DC042097 SEDATION & IMPLANT DENTISTRY113 Waterworks Way Ste 220, 92618‑3176949‑727‑07770/1 (SP)

DC042860 ALTON IMPLANT CENTER5405 Alton Pkwy Ste F, 92604‑3719949‑262‑03001/0 (HI SP)

DC044965 MANAL AZIZ DDS INC14150 Culver Dr Ste 205, 92604‑0323949‑559‑65652/0 (AR)

DC047026 THE DENTAL OFFICE ON RED HILL17010 Red Hill Ave Ste D, 92614‑5626949‑975‑01505/0

DC048933 GREEN DENTAL113 Waterworks Way Ste 130, 92618‑3168949‑502‑51001/0 (SP)

DC055967 Dent‑All By Dr 215362 Alton Pkwy, 92618‑2362949‑447‑50501/0 (AR SP)

DC059297 Formosa Dental Arts14200 Culver Dr Ste 290, 92604‑0329949‑679‑16371/0 (CH 12)

DC061621 Western Dental Services Inc14370 Culver Dr Ste A, 92604‑0319949‑733‑343311/0

DC061710 BON DENTAL4330 Barranca Pkwy Ste 140, 92604‑1703949‑523‑28751/0 (KO)

51

DeltaCare® USA

DC063284 Dentists of Irvine Dental Group5685 Alton Pkwy, 92618‑4059949‑236‑65272/0 (SP)

DC339901 FARZAD SHAYGAN DDS4040 Barranca Pkwy Ste 140, 92604‑4773949‑559‑73001/0 (SP)

Jurupa ValleyDC063511 Western Dental Services Inc4834 Etiwanda Ave Ste 200, 91752‑1823951‑688‑710612/0 (SP)

La CanadaDC053724 Tina Ghotanian DDS1370 Foothill Blvd Ste 102, 91011‑2150818‑864‑69901/0 (SP)

La Canada FlintridgeDC046681 LA CANADA SMILES DENTISTRY DENTAL GROUP2220 Foothill Blvd Ste A, 91011‑1413818‑248‑10216/0

La CrescentaDC015841 FAMILY DENTISTRY3157 Foothill Blvd Ste A, 91214‑4247818‑541‑97240/1 (AM RU SP)

DC018881 NINA SONIN DDS3043 Foothill Blvd Ste 5, 91214‑2773818‑542‑30390/1 (RU SP)

La HabraDC002721 CHESTER JENG DDS INC744 W La Habra Blvd, 90631‑5313562‑691‑07380/1 (CA CH 12 SP)

DC009542 HARBOR DENTAL CARE1150 E Imperial Hwy, 90631‑7454714‑992‑22000/1 (KO SP)

DC025175 AKSHAR DENTAL1281 E La Habra Blvd Ste 4, 90631‑5661562‑697‑37881/0 (HI SP)

DC029119 LA HABRA SMILES DENTAL1250 W Whittier Blvd, 90631‑3611562‑266‑92770/1 (SP)

DC031239 KYUNG YU DDS1370 S Beach Blvd Ste E, 90631‑1178562‑694‑58501/0 (KO SP)

DC035596 LA HABRA MODERN DENTISTRY AND ORTHODONTICS1701 W Imperial Hwy Ste B, 90631‑0604562‑690‑57292/1 (SP)

La JollaDC013282 LA JOLLA DENTAL ARTS7540 Fay Ave, 92037‑4839858‑729‑98081/0 (HI SP)

DC018814 GREY CUNNINGHAM DDS‑PROF CORP7300 Girard Ave Ste 206, 92037‑5138858‑454‑41140/1

DC040333 RENAISSANCE DENTAL CENTER4150 Regents Park Row Ste 320, 92037‑1417858‑453‑20701/0 (PT SP TA)

DC049651 LA JOLLA VILLAGE SMILES DENTISTRY AND IMPLANTS8657 Villa La Jolla Dr Ste 211, 92037‑8309858‑272‑22606/0

La MesaDC051050 PAUL H VAN HORNE DDS7200 Parkway Dr Ste 115, 91942‑1534619‑463‑58831/0

DC053128 Jeramel Jardin DDS8805 La Mesa Blvd, 91942‑5406619‑741‑83001/0 (TA)

DC054905 Great Smiles of La Mesa5208 Jackson Dr Ste 108, 91942‑7902619‑466‑44481/0 (SP)

DC056334 Rancho San Diego Dentists Dental Group3767 Avocado Blvd, 91941‑7301619‑729‑23235/0

DC056384 Affinity Dental La Mesa8881 Fletcher Pkwy Ste 325, 91942‑3194619‑697‑28002/0 (SP)

DC058439 La Mesa Modern Dental Group5620 Lake Murray Boulevard, 91942619‑324‑41952/0

DC062578 Smile Dental of San Diego5601 Grossmont Center Dr Ste 200, 91942‑3074619‑462‑22723/0 (KO SP)

DC266701 GENTLE DENTAL‑GROSSMONT5565 Grossmont Center Dr Ste 459, 91942‑3023619‑464‑33830/2 (GE KO SP TA VI)

La MiradaDC002493 IMPERIAL DENTAL15769 Imperial Hwy, 90638‑2510562‑902‑98983/0 (AM KO SP)

DC012760 NEW AGE DENTAL14545 Telegraph Rd, 90638‑1054562‑777‑11881/0 (SP)

DC013855 BEST CARE DENTAL15651 Imperial Hwy Ste 206, 90638‑1653562‑947‑25591/0 (KO SP)

DC058175 Family Dental Works15018 La Mirada Blvd, 90638‑4743714‑521‑68271/0 (FR SP VI)

DC058501 JOHN WESTERMEYER DDS11900 La Mirada Blvd Ste 7, 90638‑1337562‑947‑37611/0 (SP)

DC175301 LA MIRADA FAMILY DENTAL13922 Imperial Hwy, 90638‑1725562‑926‑70250/1 (SP)

DC359401 MAGDY & ALINA GAD12252 La Mirada Blvd, 90638‑1306562‑943‑01510/2 (AR CH SP)

La PuenteDC002085 SMILESWEST15448 Amar Rd, 91744‑2802626‑498‑89718/1 (AR AM CH FR JA KO PE PL PT SP TA TA TH)

DC003823 VIJAY PHARAR DDS17311 E Valley Blvd Ste B, 91744‑5696626‑810‑24441/0 (AR HI SP)

DC031436 FAIRGROVE FAMILY DENTISTRY15260 Fairgrove Ave, 91744‑1067626‑968‑47330/1 (CA CH 12 SP VI)

DC049321 CLINICA DENTAL DEL SOL1431 N Hacienda Blvd, 91744‑1133626‑919‑23151/0 (SP)

DC053113 Western Dental Service835 N Hacienda Blvd, 91744‑2809626‑333‑338458/0 (SP)

DC061635 K‑Care Dental Center13757 Amar Rd Ste A, 91746‑1692626‑337‑02301/0 (SP)

DC063114 La Puente Family Dentistry14285 Amar Rd, 91746‑2154626‑917‑93081/0 (SP)

La QuintaDC000631 LA QUINTA DENTAL GROUP78595 Highway 111 Ste 300, 92253‑2084760‑771‑03005/1 (SP)

DC019230 BRIGHT NOW DENTAL79255 Highway 111 # 1A1B, 92253‑8301760‑771‑120010/0

La VerneDC006423 LAVERNE DENTAL GROUP2216 Foothill Blvd, 91750‑2944909‑392‑38999/2 (SP)

DC041125 BRIGHT NOW DENTAL‑LAVERNE2497 Foothill Blvd Ste E, 91750‑3066909‑451‑032916/0

DC060006 Enayda M Enabe DDS2025 Foothill Blvd Ste B, 91750‑3560909‑593‑13471/0 (SP TA)

DC063386 La Verne Dental and Implant Center2488 Foothill Blvd Ste C, 91750‑3062909‑596‑11552/0 (AM SP)

Laguna BeachDC001503 LAGUNA BEACH DENTAL GROUP31796 Coast Hwy, 92651‑6974949‑415‑10201/1 (SP VI)

52

DeltaCare® USA

Laguna HillsDC004941 S C DENTAL CARE22972 Moulton Pkwy Ste 106, 92653‑1219949‑770‑30100/1 (SP)

DC014941 BRILLIANT SMILE23024 Lake Forest Dr Ste A, 92653‑1328949‑716‑71661/0

DC045447 TADROS DENTISTRY23141 Moulton Pkwy Ste 211, 92653‑1204949‑916‑05681/0 (AR PE SP)

DC054185 Alicia Parkway Dental25401 Alicia Pkwy Ste J, 92653‑4958949‑587‑30101/0 (SP VI)

DC056970 Laguna Hills Family Dentistry23961 Calle De La Magdalena Ste 431, 92653‑3685949‑588‑75251/0 (SP)

DC058323 Loberg Professional Dental Center23141 Moulton Pkwy Ste 210, 92653‑1204949‑586‑19302/0 (SP)

DC062570 Dr Edward H Moussally24953 Paseo De Valencia Ste 23A, 92653‑4343949‑916‑46601/0

Laguna NiguelDC001925 LAGUNA NIGUEL DENTAL GROUP27901 La Paz Rd Ste D, 92677‑3932949‑389‑91955/1 (SP)

DC054520 Choice Dental Care30262 Crown Valley Pkwy Ste E, 92677‑2364949‑363‑00181/0 (SP VI)

DC057614 Niguel Family Dentistry30001 Crown Valley Pkwy Ste G, 92677‑1723949‑495‑42451/0 (AR CH SP)

DC063751 Laguna Surgical & Cosmetic Specialist28202 Cabot Rd Ste 420, 92677‑1273949‑347‑99901/0 (SP)

DC170601 RANCHO NIGUEL DENTAL GROUP30140 Town Center Dr, 92677‑2037949‑249‑41802/0 (FR SP)

DC304801 SOBHI BATNIJI DDS30231 Golden Lantern Ste D, 92677‑5989949‑363‑12000/1 (AR FR)

Laguna WoodsDC052477 Leisure Dental24102 El Toro Rd Ste A, 92637949‑830‑65106/0 (SP)

Lake ElsinoreDC015327 MARKETPLACE DENTAL GROUP29273 Central Ave Ste A, 92532‑2254951‑245‑86644/1 (SP)

DC017778 OAK GROVE DENTAL GROUP18285 Collier Ave Ste B, 92530‑2786951‑471‑00345/2 (SP)

DC057422 Western Dental Services Inc31960 Mission Trl, 92530‑4539951‑643‑609433/0 (SP)

Lake ForestDC013278 MARINA DENTAL23591 El Toro Rd Ste 130, 92630‑4704949‑206‑95081/0 (SP)

DC062625 Family Smiles Dental Care23082 Ridge Route Dr Ste A, 92630‑3691949‑837‑27662/0 (HI KO RU SP)

DC062869 Dental Wellness of Lake Forest22373 El Toro Rd, 92630‑5053949‑444‑58331/0 (12 SP VI)

DC063619 Smile On You26741 Rancho Parkway Ste 105A, 92630949‑716‑48921/0

DC0C4801 LAKE FOREST DENTAL GROUP23704 El Toro Rd Ste A, 92630‑8906949‑770‑93554/2 (SP)

LakesideDC054051 Gregory Culton DMD9929 Channel Rd, 92040‑3003619‑561‑44301/0

LakewoodDC013223 D AND D DENTAL OFFICE4180 Woodruff Ave, 90713‑3144562‑938‑95141/1 (SP VI)

DC015836 LAKEWOOD PLAZA DENTAL GROUP4346 South St, 90712‑1152562‑408‑35000/2 (SP)

DC035364 CANDLEWOOD SMILES DENTAL GROUP4443 Candlewood St, 90712‑1736562‑634‑50426/2 (SP)

DC043229 LAKEWOOD FAMILY DENTAL GROUP5203 Lakewood Blvd, 90712‑2438562‑531‑73732/0 (AR SP)

DC052901 LAKEWOOD DENTAL ARTS5555 Del Amo Blvd, 90713‑2307562‑866‑17354/0 (HI KO SP TA)

DC056576 Lakewood Cerritos Dental5819 Adenmoor Ave, 90713‑1067562‑804‑22963/0 (AR CH 4 KO 12 PT RU SP TA TH VI)

DC329201 JITEN VASA DDS11455 Carson St Ste E, 90715‑2581562‑860‑71161/0 (HI SP)

LancasterDC001819 HI DESERT DENTAL CENTER1745 W Avenue K Ste C, 93534‑6504661‑723‑54000/2 (PE RU SP)

DC021132 BRIGHT NOW DENTAL43456 10th St W, 93534‑6004661‑945‑290010/1 (12 SP)

DC039638 WESTERN DENTAL SERVICES44407 Challenger Way, 93535‑3237661‑341‑310033/4 (SP)

DC046791 DESERT BREEZE DENTAL CARE44404 16th St W Ste 205, 93534‑2839661‑942‑14741/0 (AM SP)

DC047016 PREMIER DENTAL CARE612 W Lancaster Blvd Ste A, 93534‑3108661‑948‑96461/0 (AR FinnishHI KO SP)

DC055786 Lancaster Modern Dentistry Dental Group43531 10th St W, 93534‑6005661‑839‑76304/0 (SP)

DC056321 Elite Dental Care44439 17th St W Ste 201, 93534‑2856661‑723‑14611/0 (AM CA KO 12 SP)

DC058757 Eagle Dental1306 W Avenue J Ste A, 93534‑2936844‑563‑24531/0 (CH SP)

DC059118 West Lancaster Dental Group1669 W Avenue J Ste 305, 93534‑2870661‑802‑75445/0 (KO SP)

DC061922 Western Dental Services Inc2004 W Avenue J, 93536‑5913661‑949‑197018/0 (SP)

DC378501 KAMRAM SAIDARA DDS2030 W Avenue J, 93536‑5913661‑949‑67571/0 (AR PE PT SP)

LawndaleDC002783 DENTAL CENTER OF REDONDO BEACH16819 Hawthorne Blvd, 90260‑3219310‑921‑39380/1 (AM SP)

DC011201 HAWTHORNE DENTAL15017 Hawthorne Blvd, 90260‑1504310‑973‑64280/1 (AM CH KO PT RU SP)

DC013518 HANNA DENTISTRY14314 Hawthorne Blvd, 90260‑1515310‑676‑64001/0 (AR SP)

DC020267 BRIGHT NOW DENTAL16128 Hawthorne Blvd, 90260‑2931310‑370‑451121/0 (IN KO 12 SP)

53

DeltaCare® USA

LemooreDC063122 United Health Centers of the San Joaquin Valley250 E Hanford Armona Rd, 93245‑2141559‑997‑61402/0 (SP VI)

Loma LindaDC059061 Ronald L Moore DDS Inc25835 Barton Rd Ste 104, 92354‑3898909‑796‑22991/0 (SP)

DC059207 Western Dental Services Inc25733 Barton Rd, 92354‑3812909‑798‑275529/0

LomitaDC008858 SHANNON YOON DDS25124 Narbonne Ave Ste 202, 90717‑2141310‑530‑32601/0 (SP)

DC037047 DAVID SUH DDS INC25609 Narbonne Ave, 90717‑2513310‑326‑85721/0 (JA KO SP VI)

DC060233 St Francis Dental2055 Lomita Blvd, 90717‑1701310‑530‑31001/0 (SP)

LompocDC058634 Ericson Dental Group Lompoc719 E Ocean Ave, 93436‑7014805‑735‑27021/0 (SP)

DC058635 Prasan Mohansinh Parmar DDS1133 N H St Ste L, 93436‑3383805‑736‑80111/0 (HI SP)

Long BeachDC000633 UNITED FAMILY DENTAL141 E Willow St Ste P, 90806‑2634562‑988‑28881/0 (HI KO SP TA VI)

DC011675 BEAUTIFUL SMILES DENTAL CARE1729 Termino Ave, 90804‑2121562‑494‑84000/1 (SP)

DC013333 VICTOR DE LOS SANTOS DDS INC3712 Atlantic Ave Ste C, 90807‑3542562‑426‑12980/2 (SP TA TA)

DC015864 OMEGA FAMILY DENTAL816 W Willow St, 90806‑2837562‑595‑70771/0 (CH SP VI)

DC018976 ACCU DENTAL GROUP6413 E Spring St, 90808‑4022562‑938‑83880/1 (SP VI)

DC023648 NEWPORT DENTAL3383 Long Beach Blvd, 90807‑4408562‑424‑160019/0 (KO SP)

DC024563 BASHAR KOMOC DDS3318 E Anaheim St, 90804‑4025562‑986‑55701/0 (GE RU SP)

DC037979 GARY TROMBATORE & KENNY ABEDINI3816 Woodruff Ave Ste 104, 90808‑2145562‑425‑05452/0 (SP TA VI)

DC039876 WESTERN DENTAL SERVICES1150 E Anaheim St, 90813‑3663562‑437‑064658/10 (SP)

DC047786 DR ZAK LONG BEACH DENTAL CARE3620 Long Beach Blvd Ste B6, 90807‑6008562‑426‑645812/0 (RU SP)

DC056895 Marina Smiles Dentistry dental Group6437 E Pacific Coast Hwy Unit A‑6, 90803‑4201562‑280‑52004/0

DC059510 Western Dental Services Inc2360 Pacific Ave, 90806‑3051562‑595‑073127/0

DC061590 Cherry Dental6616 Cherry Ave, 90805‑1715562‑630‑22621/0 (AR SP)

DC061686 Western Dental Services Inc4516 Atlantic Ave, 90807562‑495‑623747/0

DC061850 Carson Dental & Cosmetic Centre1200 E Carson St Ste 300, 90807‑3075562‑988‑77881/0 (CH KO SP)

DC062542 Bixby Knolls Modern Dentistry Dental Group4578 Atlantic Ave, 90807‑1513310‑579‑64652/0 (SP)

DC062817 Family Dentistry5399 Orange Ave, 90805‑6017562‑422‑10001/0 (SP)

DC063204 Western Dental Services Inc2306 E 7th St, 90804‑4619562‑434‑07405/0 (SP)

DC359201 MARK COCCHI DDS2880 Atlantic Ave Ste 190, 90806‑1724562‑426‑07781/0 (GE)

Los AlamitosDC051429 LOS ALAMITOS FAMILY DENTISTRY3662 Katella Ave Ste 206, 90720‑3192562‑598‑79141/0

DC187701 LOS ALAMITOS DENTAL ARTS3724 Katella Ave, 90720‑3102562‑936‑00711/1 (SP)

DC283401 ASHOKKUMAR MEHTA DDS10900 Los Alamitos Blvd Ste 133, 90720‑5612562‑596‑88881/1 (AR FR HE HI SP)

Los AngelesDC000635 CENTRO MEDICO DENTAL FAMILIAR514 E Washington Blvd, 90015‑3723213‑749‑39342/0 (RU SP)

DC000759 Samaritana Dental504 S Alvarado St Ste 208, 90057‑2914213‑335‑35902/0 (SP TA)

DC001664 WILSHIRE SMILE STUDIO DTL GRP6200 Wilshire Blvd Ste 1609, 90048‑5817323‑336‑84782/1 (HE)

DC002326 FRED NAYSSAN DDS10350 Santa Monica Blvd Ste 190, 90025‑5073310‑557‑17042/0 (SP TA)

DC002507 BRENTWOOD DENTAL GROUP11980 San Vicente Blvd Ste 660, 90049‑6641310‑979‑8345 1/0 (AR FR SP)

DC002540 WOODSIDE DENTAL1273 Westwood Blvd, 90024‑4899310‑824‑00551/0 (TA)

DC002865 CYPRESS DENTAL CLINIC2135 Cypress Ave, 90065‑1212323‑223‑07311/0 (HI SP)

DC002866 JOCELYN CAPISTRANO DDS628 N Vermont Ave Ste 5, 90004‑2154323‑644‑36501/0 (SP TA)

DC003153 ADELAIDA QUINGCO DDS1127 Wilshire Blvd Ste 1103, 90017‑4002213‑250‑39981/0 (SP TA)

DC005210 VENICE DENTAL GROUP INC12563 Venice Blvd, 90066‑3712310‑390‑24231/0 (AR SP)

DC005901 JAMES BLACK DDS3015 Crenshaw Blvd Ste A, 90016‑4264323‑731‑08014/0 (FR KO SP)

DC006471 ST GEORGE DENTAL CLINIC7260 W Sunset Blvd Ste 201, 90046‑3417323‑469‑88161/0 (AR RU SP)

DC006734 RAMIN TOUR DDS INC907 N Virgil Ave, 90029‑2911323‑661‑83840/1 (FR SP TA)

DC007538 AIRPORT CENTER FAMILY DENTAL5304 W Century Blvd, 90045‑5910310‑215‑14551/1 (SP)

DC008727 NEWPORT DENTAL3635 E 1st St, 90063‑2345909‑624‑61997/1 (SP)

DC009138 OJAN GHALCHI DMD281 Columbia Ave, 90026‑5971213‑483‑30201/0 (SP)

54

8

DeltaCare® USA

DC009538 BEVERLY HILLS PRESTIGE DENTAL1125 S Beverly Dr Ste 400, 90035‑1152310‑286‑74471/0 (HE SP)

DC010344 WILSHIRE DENTAL CARE6200 Wilshire Blvd Ste 1508, 90048‑5816323‑931‑20001/1 (HI PE RU SP)

DC012440 WILSHIRE DENTAL GROUP6200 Wilshire Blvd Ste 1104, 90048‑5812323‑525‑18191/0 (AM RU SP)

DC012441 AMY IWATA DDS3756 Santa Rosalia Dr Ste 504, 90008‑3656323‑293‑26001/0

DC014328 THEODORE STOMEL DMD6333 Wilshire Blvd Ste 208, 90048‑5724323‑653‑13000/2 (RU)

DC014615 MANUEL LAZO JR DDS3827 W Sunset Blvd Ste A, 90026‑1594323‑660‑56301/0 (TA)

DC014858 PERSONAL DENTAL OFFICE6222 Wilshire Blvd Ste 103, 90048‑5100323‑933‑44440/1 (PT RU SP)

DC016202 IMPRESSIVE DENTAL1435 S Vermont Ave Ste 101, 90006‑4543213‑739‑30960/1 (SP)

DC017531 PREMIER DENTAL CLINIC INC1115 Colorado Blvd, 90041‑2503323‑255‑46000/1 (AM SP)

DC017534 WEST COAST DTL GRP 6TH STREET1725 W 6th St, 90017‑1000213‑413‑515114/1 (AR AM CH FR KO SP VI)

DC018373 ARAM ARAKELYAN DDS2426 W 8th St Ste 209, 90057‑3872213‑381‑39000/0 (AM SP)

DC018953 LA PAZ CLINIC1107 S Alvarado St Ste 102, 90006‑4161213‑380‑99993/1 (HE SP)

DC019946 DAVIS FAMILI DDS MAGD INC11500 W Olympic Blvd Ste 508, 90064‑1528310‑477‑77440/1 (SP)

DC021424 NORMANDIE DENTAL CLINIC1690 W Adams Blvd, 90007‑1535323‑730‑09241/0 (AM RU SP)

DC021502 FOREVER SMILE DENTAL CARE6200 Wilshire Blvd Ste 1604, 90048‑5817323‑634‑90040/1 (SP)

DC022103 AFAR & GHASRI DENTAL CORP6200 Wilshire Blvd Ste 1508, 90048‑5816323‑931‑20000/1 (SP TA)

DC022394 HENGAMHEH ANARAKI DDS INC244 S Oxford Ave Ste 12, 90004‑5126213‑388‑55331/0 (SP)

DC024589 SMILE MAKERS998 S Robertson Blvd, 90035‑1637310‑358‑12001/0 (SP)

DC026085 MARK A MOSES DDS1839 W Imperial Hwy, 90047‑5021323‑757‑17611/0 (SP)

DC027694 GENTLE FAMILY DENTIST5207 Whittier Blvd, 90022‑4012323‑269‑02662/0 (HI SP)

DC028254 WESTWOOD DENTAL CARE10921 Wilshire Blvd Ste 601, 90024‑4003310‑208‑85511/0 (KO SP)

DC029955 RAMIN RAVAEI DMD1835 S La Cienega Blvd Ste 200, 90035‑4648310‑836‑03001/0 (KO SP TA)

DC033266 MICHAEL SCHNEIDER DMD10921 Wilshire Blvd Ste 809, 90024‑4003310‑208‑68130/1 (JA SP)

DC033797 FLORENCE DENTAL GROUP1575 E Florence Ave Ste A, 90001‑2555323‑537‑41211/0 (HE SP)

DC034767 PICO DENTAL GROUP1561 W Pico Blvd, 90015‑2407213‑251‑99940/1 (SP)

DC036135 GANJI AND KAMANGAR DENTAL1005 E Washington Blvd Ste B, 90021‑3020213‑765‑00042/0 (AR SP)

DC036164 HR IMANKHAN DDS INC3356 E Olympic Blvd, 90023‑3724323‑269‑52211/0 (FR SP TA)

DC036961 HISTORIC CORE DENTAL CARE111 W 7th St Ste R5, 90014‑3951213‑629‑92221/1 (SP)

DC038015 Z DENTAL GRP6320 Commodore Sloat Dr Ste 1, 90048‑5453323‑936‑99974/0 (AR AM PE RU SP)

DC039584 WOO SUNG PARK DENTAL CORP3130 W Olympic Blvd Ste 320, 90006‑2494323‑766‑28881/0 (KO)

DC039636 WESTERN DENTAL SERVICES1565 S Western Ave, 90006‑4233323‑734‑884345/5 (SP)

DC039892 WESTERN DENTAL SERVICES906 S Soto St, 90023‑1323323‑263‑906338/1

DC039893 LA BREA FAMILY DENTAL GROUP3400 S La Brea Ave, 90016‑5217323‑734‑22841/0 (KO SP)

DC040123 JAY J CHOBDEE DDS2105 Beverly Blvd Ste 101, 90057‑2248213‑484‑12882/0 (SP TA)

DC040228 ANTHONY S PAN DMD INC3346 N Eastern Ave, 90032‑1948323‑227‑18001/0 (CA CH 12 SP VI)

DC040862 ALLURE DENTISTRY1872 S Sepulveda Blvd Ste 2, 90025‑4314310‑444‑91211/0 (AR HE HI PT SP)

DC042201 PATRICK CLERK DDS1200 Wilshire Blvd Ste 615, 90017‑1995213‑481‑12521/0

DC042336 DENTAL PARK753 S Vermont Ave, 90005‑151213‑385‑28751/0 (KO SP)

DC042903 WESTWOOD DENTAL ARTS CENTER10921 Wilshire Blvd Ste 501, 90024‑4001310‑443‑30302/0 (SP)

DC043761 BRIGHT NOW DENTAL4550 W Pico Blvd Ste C309, 90019‑4271323‑602‑05906/0

DC043916 ANGELENOSMILE10921 Wilshire Blvd Ste 510, 90024‑4001310‑824‑26241/0 (AR AM FinnishHE PE SP TA)

DC044490 WEST COAST DENTAL GROUP2604 S Vermont Ave Ste F, 90007‑2298323‑731‑33337/1 (SP)

DC044501 WILSHIRE CENTRAL DENTAL GROUP3932 Wilshire Blvd Ste 100, 90010‑3307213‑386‑33368/0 (SP)

DC044525 BRIGHT NOW DENTAL8611 S Sepulveda Blvd, 90045‑4001310‑846‑017213/2

DC046688 WESTERN DENTAL SERVICES INC4165 Beverly Blvd, 90004‑4418323‑662‑073838/0 (SP)

DC046742 WESTERN DENTAL SERVICES INC1054 Vine Street, 90038‑2745323‑465‑905543/0 (SP)

DC047810 HOUSE OF DENTAL HEALTH530 E Washington Blvd Ste A, 90015‑3723213‑222‑29901/0 (SP)

DC047869 PACIFIC OCEAN DENTAL5161 Pomona Blvd Ste 112, 90022‑1772323‑262‑26001/0 (KO SP)

55

DeltaCare® USA

DC050881 BRIGHT AND WHITE DENTISTRY3171 Glendale Blvd, 90039‑1805323‑663‑31221/0 (AM RU SP)

DC052861 Western Dental Services Inc355 W Manchester Ave, 90003‑3327323‑751‑410033/0

DC052869 Western Dental Services Inc4364 S Central Ave, 90011‑3527323‑232‑526639/0 (AM RU SP)

DC053114 Western Dental Service12420 Venice Blvd, 90066‑3840310‑482‑001435/0 (SP)

DC055285 E Dental Center3456 Motor Ave Ste 105, 90034‑4737424‑258‑60181/0 (SP TA TA VI)

DC055390 Jabeen Mah Khan DDS Inc643 W Manchester Ave, 90044‑5718323‑753‑14111/0

DC055462 Salud Dental2621 E 1st St, 90033‑3505323‑268‑93862/0 (SP)

DC056230 LA Smiles Dentistry5010 S La Brea Ave, 90056‑1800323‑296‑23001/0 (SP)

DC056403 Afsoon Barkhordar DDS Inc6200 Wilshire Blvd Ste 909, 90048‑5810323‑935‑21112/0

DC056767 Gary Manukyan DDS Inc1828 Hyperion Ave, 90027‑4738323‑543‑00431/0 (SP)

DC057047 Just Smile Dental Center1269 S Union Ave, 90015‑2043213‑251‑14001/0 (SP TA)

DC057353 Brite Dental3530 Wilshire Blvd Ste 150, 90010‑2324213‑739‑28281/0 (KO SP)

DC057590 Just Smile Dental Center309 S Vermont Ave, 90020‑1806213‑382‑55551/0 (SP TA)

DC058347 The Culver Marina Dental Group12756 W Washington Blvd, 90066‑2309310‑822‑60662/0 (FR SP)

DC058792 Western Dental Services Inc1200 W Martin Luther King Jr Blvd, 90037‑1722323‑295‑800437/0 (SP)

DC059229 Western Dental Services Inc2839 N Eastern Ave, 90032‑2701323‑897‑10208/0

DC059380 Crystal Dental2206 S Figueroa St, 90007‑2049213‑748‑84481/0 (SP)

DC060092 Victor De Los Santos DDS201 S Alvarado St Ste 402, 90057‑2353213‑484‑29191/0 (SP TA)

DC060206 All In One Dental8930 S Sepulveda Blvd Ste 118, 90045‑3606310‑645‑60332/0 (HE RU SP)

DC060411 Smile Makers Dental Office2105 Beverly Blvd Ste 229, 90057‑2283213‑908‑66551/0 (HE SP)

DC060418 Dental Park3663 W 6th St Ste 110, 90020‑3047213‑380‑17671/0 (KO SP)

DC060548 Westchester Dental Samia Ali DDS8540 S Sepulveda Blvd Ste 1000, 90045‑3808310‑649‑24301/0 (AR SP)

DC061085 Family Dental Care 4 You5602 W Manchester Ave, 90045‑4416310‑450‑03001/0 (PL SP TA)

DC061201 Brighter Dental6221 Wilshire Blvd Ste 507, 90048‑5223323‑939‑78991/0 (SP)

DC061202 Affinity Cosmetic Center1345 S La Brea Ave, 90019‑2916818‑884‑43381/0

DC062139 Pico LaCienega Dental Group8530 W Pico Blvd, 90035‑2410310‑854‑61071/0 (SP)

DC062179 Welcome Dentistry2500 W 8th St Ste 106, 90057‑3860213‑381‑28271/0 (KO SP)

DC062245 Smiles West Los Angeles1440 W Manchester Ave, 90047‑5422323‑753‑11412/0 (AR AM CH FinnishFR JA KO PL RU SP TH TR)

DC063183 Joshua Barkhordar DDS Inc2390 Glendale Blvd, 90039‑3209323‑922‑60161/0 (AM HE SP)

DC092401 Smile Comfort Dental5220 W Washington Blvd Ste 103, 90016‑1331323‑933‑56412/0 (AR CH 12 RU SP TA)

DC0C7201 AMERICAN HEALTH PRO3130 S Sepulveda Blvd Ste D, 90034‑4214310‑268‑06461/0 (AR AM CH HE 12 RU SP TA)

DC152101 CALIFORNIA DENTAL CARE11628 Santa Monica Blvd Ste 101, 90025‑2965310‑207‑10600/1 (SP)

DC198001 UNITED FAMILY DENTAL GROUP5109 Whittier Blvd, 90022‑3926323‑265‑22221/0 (SP)

DC211901 CULVER DEL REY DENTAL OFFICE12202 W Washington Blvd, 90066‑5508310‑915‑97972/0 (AM FR SP)

DC228301 GENTLE CARE DENTAL INC3500 Whittier Blvd Ste 101, 90023‑1746323‑264‑88341/0 (CH SP)

DC270601 BYUNG CHUL KIM DDS765 N Virgil Ave, 90029‑3646323‑665‑58871/0 (KO SP)

DC349001 CHERYL BINGHAM DDS11905 S Central Ave Ste 203, 90059‑2897323‑564‑75041/0 (SP)

DC353301 DEVANG GANDHI DENTAL CORP2500 W Florence Ave, 90043‑5144323‑750‑20821/0 (HI SP)

DC372501 MEHRDAD MAKHANI DDS6200 Wilshire Blvd Ste 1606, 90048‑5817323‑933‑77441/0 (SP)

DC375201 HOLLYWOOD SMILE DENTAL CENTER8182 W Sunset Blvd Ste 202, 90046‑2440323‑654‑11001/0 (AM GE HE RU SP)

DC393401 SID SOLOMON DDS1620 Westwood Blvd, 90024‑5604310‑475‑55980/1 (FR SP)

LynwoodDC009863 SMILESWEST11035 Long Beach Blvd Ste 5, 90262‑2570310‑945‑27046/1 (AR AM CH FR HI JA KO 12 PE PL PT RU SP TA TA TH TR VI)

DC049649 UNITED FAMILY DENTAL10721 Atlantic Ave Ste J, 90262‑2352310‑761‑11111/0

DC059509 Western Dental Services Inc3680 E Imperial Hwy Ste 100, 90262‑2663310‑761‑810026/0

Manhattan BeachDC2C1401 MANHATTAN VILLAGE DENTAL GRP1200 Rosecrans Ave Ste 210, 90266‑2470310‑414‑06200/1

DC2C2701 MANHATTAN BEACH DENTISTRY500 S Sepulveda Blvd Ste 210, 90266‑6976310‑372‑81880/1 (SP)

Marina Del ReyDC021402 MARINA DENTISTRY INC4292 Lincoln Blvd, 90292‑5655310‑578‑50001/1 (AR SP)

DC056746 MARINA FAMILY DENTAL13286 Fiji Way, 90292‑7119310‑821‑26112/0 (AR AM FR HE RU SP)

56

DeltaCare® USA

DC059733 Design Dental Spa3206 Washington Blvd, 90292‑5553310‑822‑38331/0 (AM HE RU SP TA)

MaywoodDC039639 WESTERN DENTAL SERVICES4487 Slauson Ave, 90270‑2943323‑773‑996146/7 (SP)

DC159601 SOUTHEAST DENTAL GROUP4332 Slauson Ave, 90270‑2848323‑771‑77773/0 (GE 12 SP VI)

MenifeeDC026853 MENIFEE SMILES DENTISTRY30406 Haun Rd Ste 740, 92584‑6816951‑679‑462410/2

DC057050 Menifee Dental Group29950 Haun Rd Ste 302, 92586‑6527951‑679‑16678/0

DC057987 West Coast Dental Group of Menifee30035 Haun Rd Unit B, 92584‑6805951‑566‑90905/0 (SP)

DC062540 Menifee Lakes Dental Group29121 NEWPORT RD STE 101, 92584951‑228‑92963/0 (SP)

Mira LomaDC022611 MIRA LOMA SMILES DENTISTRY DENTAL GROUP6445 Pats Ranch Rd Ste G, 91752‑4439951‑808‑58814/2 (SP)

Mission HillsDC053367 Devonshire Dental Group15534 Devonshire St Unit 108, 91345‑2673818‑894‑64112/0 (12 SP)

DC062434 Barouir Deirmenjian10331 Sepulveda Blvd, 91345‑2421818‑810‑32903/0 (AM CH JA KO SP TH)

DC063954 Mission Hills Modern Dentistry Dental Group10306 Sepulveda Blvd, 91345‑2422818‑722‑15761/0 (SP)

Mission ViejoDC008877 GENTLE DENTAL MISSION VIEJO25523 Marguerite Pkwy Ste C, 92692‑2925949‑768‑18006/0 (SP)

DC014271 MISSION DENTAL GROUP26032 Marguerite Pkwy # A1, 92692‑5281949‑582‑84004/1 (SP)

DC015611 MISSION VIEJO FAMILY DENTISTRY28201 Marguerite Pkwy Ste 10, 92692‑3719949‑347‑03021/1 (SP)

DC019948 MARGUERITE DENTAL CARE27871 Medical Center Rd Ste 165, 92691‑6425949‑364‑25291/0 (FR SP)

DC021408 MISSION VIEJO DENTAL23482 Alicia Pkwy, 92691‑2601949‑581‑009013/1

DC022891 JAMES VARTANIAN DDS INC26302 La Paz Rd Ste 203, 92691‑5328949‑586‑56691/0 (SP)

DC055935 Saddleback Dental Associates23166 Los Alisos Blvd Ste 230, 92691‑7867949‑457‑02231/0 (RU)

DC057404 Blessed Smile Dentistry of Mission Viejo23032 Alicia Pkwy Ste D, 92692‑1600949‑916‑16102/0

DC059706 Alicia Orthodontic & Pediatric Dental Specialties24481 Alicia Pkwy Ste B3, 92691‑4534949‑586‑98002/0 (SP)

DC060817 Sunshine Smiles of Orange County27725 Santa Margarita Pkwy Ste 270, 92691‑6708949‑541‑87221/0

DC063006 H Koh Dental Corp25100 Marguerite Pkwy Ste A, 92692‑2467949‑768‑38011/0 (KO SP)

Monrovia

DC039133 MONROVIA MODERN460 W Huntington Dr, 91016‑3202626‑358‑36363/1 (AM HI SP)

DC044638 DENTAL CARE 2000 PLUS115 W Foothill Blvd, 91016‑2144626‑358‑18331/0 (AR SP)

MontclairDC050329 GLAMOUR DENTAL CARE9509 Central Ave Ste D, 91763‑2400909‑399‑33301/0 (AR AM SP)

DC061365 Eagle Dental5467 Moreno St Ste A, 91763‑1682844‑563‑24531/0 (CH SP)

DC179501 CENTRAL FAMILY DENTISTRY9197 Central Ave Ste C, 91763‑1616909‑398‑11071/0 (SP TA TA)

DC3C2501 AMIEL PATEL DDS4921 Moreno Street, 91763‑1522909‑625‑38651/0

MontebelloDC025188 MONTEBELLO DENTAL CENTER2453 W Beverly Blvd, 90640‑2305323‑838‑80551/0 (KO SP)

DC058825 Western Dental Center2200 W Beverly Blvd Ste 400, 90640323‑476‑303227/0

DC060238 Tigran Shahmanyan DDS Inc3001 W Beverly Blvd Ste 100, 90640‑2255323‑728‑03271/0 (AM RU SP)

DC062503 Smiles West Montebello1451 N Montebello Blvd, 90640‑2584323‑724‑99552/0 (AR AM CH FR KO PL PT SP TH)

DC063177 Montebello Dental Group3301 W Beverly Blvd, 90640‑1536323‑722‑67661/0 (SP)

DC363901 S GHAZARIAN DDS433 N Montebello Blvd, 90640‑4222323‑722‑29221/0 (AM SP)

Monterey ParkDC039748 CLEAR CHOICE DENTAL2312 S Garfield Ave, 91754‑7220323‑722‑13150/1 (CH SP VI)

DC053700 Pacific Smile Dental Group2111 S Atlantic Blvd, 91754323‑261‑99995/0

DC196401 PACIFIC DENTAL GROUP2016 S Atlantic Blvd, 91754‑6843323‑725‑67970/1 (AM FR IT KO RU SP)

DC239601 ISAAC CHEN DDS2071 S Atlantic Blvd Ste F, 91754‑6347323‑260‑78780/1 (CA 12 SP)

MontroseDC061280 Montrose Smiles3901 Ocean View Blvd, 91020‑1514818‑249‑32131/0 (CH 12 SP)

MoorparkDC020308 MOORPARK DENTAL GROUP718 W Los Angeles Ave Ste 3, 93021‑1756805‑529‑17436/1 (SP)

DC063230 SMILES AVENUE ADVANCED COSMETIC DENTISTRY530 Moorpark Ave Ste 140, 93021‑1877805‑529‑59551/0 (HI SP)

Moreno ValleyDC009130 GENTLE DENTAL MORENO VALLEY12800 Heacock St Ste A1, 92553‑2868951‑247‑26882/2 (SP)

DC010509 BRIGHT NOW DENTAL12420 Day St # B4, 92553‑7536951‑656‑653816/0 (SP)

DC015837 ST PATRICK DENTAL CLINIC24655 Sunnymead Blvd, 92553‑3760951‑242‑60880/1 (SP TA TA)

DC022469 STONERIDGE DENTAL GROUP27110 Eucalyptus Ave Ste A, 92555‑4542951‑616‑17593/2 (SP)

57

DeltaCare® USA

DC034810 IMAGE DENTISTRY23205 Sunnymead Blvd, 92553‑5246951‑242‑62421/0 (KO SP)

DC035115 DR PAREDES DENTAL OFFICE23318 Olive Wood Plaza Dr Ste C, 92553‑5219951‑242‑55851/0 (SP)

DC044310 WESTERN DENTAL SERVICES23185 Hemlock Ave Ste 1, 92557‑8043951‑243‑078460/10 (SP)

DC048665 TOWNGATE FAMILY DENTAL AND ORTHO12625 Frederick St Ste F4, 92553‑5234951‑697‑77501/0 (KO SP)

DC057020 BRIGHT NOW DENTAL‑MORENO BEACH12761 Moreno Beach Dr Ste 103, 92555951‑902‑60689/0

DC062433 SMILES WEST MORENO VALLEY12252 Perris Blvd Ste B, 92557‑7418951‑801‑43825/0 (AR AM CH FinnishFR KO PL SP TH)

DC063182 IC Smiles Family Dentistry24760 Sunnymead Blvd Ste 103, 92553‑3791951‑807‑30781/0 (SP)

DC273301 ROBERT SILVOLA DDS12810 Heacock St Ste B103, 92553‑3171951‑242‑34411/0 (SP)

DC396301 DTL ASSOC MORENO VALLEY MALL22500 Town Cir Ste 2074, 92553‑7527951‑697‑68001/0 (HI 4 KO SP TH VI)

MurrietaDC003165 MURRIETA DENTAL GROUP25395 Madison Ave Ste 103, 92562‑9003951‑696‑56602/2

DC013121 EAST MURRIETA DENTAL GROUP39209 Winchester Rd Ste 100, 92563‑3513951‑304‑13484/2 (SP)

DC017410 MARGARITA DENTAL GROUP39400 Murrieta Hot Springs Rd Ste 123B, 92563‑7709951‑461‑74700/1 (AM CH IT PT SP TH VI)

DC017779 PLAZA DENTAL GROUP40484 Murrieta Hot Springs Rd Ste 102, 92563‑6437951‑461‑43063/1 (SP VI)

DC036403 FRIENDLY DENTAL CENTER39252 Winchester Rd Ste 117, 92563‑3511951‑894‑77692/0 (SP)

DC037610 COPPER CANYON SMILES23771 Washington Ave Ste H102, 92562‑2265951‑691‑50960/1 (SP)

DC040220 BRIGHT NOW DENTAL‑MURRIETA40790 California Oaks Rd Ste A, 92562951‑704‑774016/3

DC053115 Western Dental Services25155 Madison Ave Ste 101, 92562‑8975951‑834‑975059/0 (SP)

DC058837 Gentle Dental Murrieta39872 Los Alamos Rd Ste A1, 92562‑5871951‑397‑45262/0

DC063337 Carlos L Torres25341 Madison Ave Ste 103, 92562‑9000951‑677‑21151/0 (SP)

DC0C2201 MURRIETA DENTAL GROUP40760 California Oaks Rd, 92562‑5794951‑677‑30786/1 (SP)

DC3C8601 MURRIETA FAMILY DENTAL GROUP40643 California Oaks Rd, 92562‑5729951‑677‑77792/0 (KO SP)

N HollywoodDC002840 PACIFIC DENTAL GROUP6801 Lankershim Blvd Ste 101, 91605‑6112818‑764‑07180/1 (AM IT KO RU SP)

DC003546 HAMLIN DENTAL GROUP12509 Oxnard St Ste 201, 91606‑4440818‑285‑57570/2 (AR AM CA CH IT 12 PT SP TA)

DC015654 HERSEL HANASAB DDS12926 Sherman Way, 91605‑4953818‑765‑44221/1 (AM SP)

DC021129 NORTH HOLLYWOOD DENTAL GRP12125 Vanowen St Ste 2, 91605‑5665818‑764‑46790/1 (AM SP TR)

DC046526 WESTERN DENTAL SERVICES INC12700 Sherman Way, 91605‑5031818‑764‑884347/0

DC349801 JULIAN GERSHFELD DDS5160 Vineland Ave Ste 105, 91601‑3888818‑761‑88990/1 (RU SP TA)

National CityDC035369 SOUTH COAST DENTAL202 Mile Of Cars Way, 91950‑6605619‑477‑19704/0 (SP TA)

DC036282 WESTERN DENTAL SERVICES1539 E Plaza Blvd Ste A, 91950‑3641619‑474‑790033/9 (SP TA)

DC053793 South Bay Plaza Dental1210 E Plaza Blvd Ste 405, 91950‑3628619‑477‑27871/0

DC056968 Beautiful SmilesDental3403 E Plaza Blvd Ste G, 91950‑4140619‑267‑65992/0 (SP TA)

Newbury ParkDC047796 PARK PLACE DENTAL GROUP501 S Reino Rd Ste G, 91320‑4276805‑499‑44412/0 (SP)

DC063833 Community Dental Group587 N Ventu Park Rd Ste C, 91320‑2743805‑499‑12531/0 (SP)

NewhallDC014829 MITRA SIMANIAN DDS INC23107 Lyons Avenue, 91321‑2630661‑255‑73382/0 (AM CA CH FR IT KO 12 PE SP)

DC032350 JERROLD SINGER DDS25061 Peachland Ave, 91321‑2517661‑255‑75300/1 (SP)

Newport BeachDC013066 AMIT SHAH DDS355 Placentia Ave Ste 100, 92663‑3301949‑646‑08181/0 (KM GE HI SP)

DC016544 COASTAL IMAGE DENTAL3991 Macarthur Blvd, 92660949‑863‑09883/0 (CH SP)

DC029951 OMID HARONIAN DDS1901 Westcliff Dr Ste 6, 92660‑5505949‑646‑24811/0 (SP)

DC047391 NEWPORT DENTAL CENTER2105 San Joaquin Hills Rd, 92660‑6507949‑721‑17301/0 (SP)

DC062099 Leo S Shin DDS Inc1401 Avocado Ave Ste 701, 92660‑8709949‑644‑45711/0 (KO SP)

DC062232 Kids R US Dental And Adults325 Old Newport Blvd Ste 3, 92663‑4161949‑873‑57101/0 (SP VI)

DC062312 Luminous SMiles of Newport Beach180 Newport Center Dr Ste 100, 92660‑6997949‑719‑34001/0 (HI SP)

DC062581 Kord Cosmetic Dentistry200 Newport Center Dr Ste 301, 92660‑7504949‑423‑36921/0 (PE SP)

DC125801 NEWPORT BEACH DENTAL1501 Superior Ave Ste 100, 92663‑3606949‑650‑67723/0 (GE RO SP)

58

Y

03

‑

DeltaCare® USA

NorcoDC006984 GENTLE DENTAL NORCO1260 Hamner Ave Ste C & D, 92860‑3136951‑279‑52003/0

DC015152 HAMNER DENTAL GROUP140 Hidden Valley Pkwy Ste K, 92860‑4002951‑898‑86734/2 (SP)

DC142201 NORCO FAMILY DENTAL2031 River Rd, 92860‑3307951‑372‑90940/1 (SP)

North HillsDC058339 Maghiran Dental Corp9506 Sepulveda Blvd, 91343‑3306818‑891‑11361/0 (SP TA)

North HollywoodDC001667 FAMILY DENTISTRY6738 Lankershim Blvd, 91606‑1615818‑503‑96970/1 (RU SP)

DC041338 ALLURE DENTAL6058 Lankershim Blvd, 91606‑4806818‑766‑00560/1 (AM RU SP)

NorthridgeDC002753 HOMA SHAHRIARI DDS INC8632 Balboa Blvd, 91325‑3505818‑894‑61611/0 (SP)

DC008246 NORTHRIDGE DENTAL OFFICE18519 Devonshire St, 91324‑1308818‑831‑999010/1 (SP)

DC018017 SHANRAM NOURI DENTAL CORP9318 Reseda Blvd, 91324‑2926818‑885‑52001/0 (AM SP)

DC056350 Comfort Dental Group9068 Tampa Ave, 91324‑3523818‑734‑90301/0 (AM SP)

DC058952 Northridge Advanced Dentistry8954 Reseda Blvd Ste 100, 91324‑5838818‑701‑30102/0 (RU SP)

DC061830 Angela Hoffman DDS Inc9535 Reseda Blvd Ste 313, 91324‑6030818‑885‑72301/0 (RU SP)

DC176401 HAMLIN DENTAL GROUP8540 Reseda Blvd Ste 101, 91324‑6144818‑701‑66670/2 (AR AM CH SP TA)

NorwalkDC002720 NORWALK FAMILY DENTISTR15617 Studebaker Rd Ste 5, 90650‑5471562‑484‑39361/0 (SP TA)

DC003204 NORWALK FAMILY DENTAL12319 Imperial Hwy, 90650‑83562‑868‑79551/0 (SP)

DC012590 PIONEER DENTAL INC14034 Pioneer Blvd, 90650‑3900562‑863‑87790/1 (SP)

DC013140 NEWPORT DENTAL11481 Rosecrans Ave, 90650‑3830562‑863‑34575/4 (SP)

DC015591 BRIGHT NOW DENTAL‑NORWALK12052 Imperial Hwy Ste 101, 90650‑3087562‑863‑477512/1 (SP)

DC045730 NORWALK DENTISTRY11850 Firestone Blvd Ste 6, 90650‑2979562‑864‑10111/0 (PE SP)

DC057655 Dental Care of Norwalk14509 Pioneer Blvd, 90650‑4875562‑863‑57011/0 (HI SP)

DC364001 ROBERT C C LEE FAMILY DTL11780 Firestone Blvd, 90650‑2899562‑868‑98971/0 (CH SP TA)

OceansideDC007275 COLLEGE DENTAL GROUP467 College Blvd Ste 2, 920575436760‑631‑306010/1 (SP)

DC011144 QUARRY CREEK DENTAL GROUP3430 Marron Rd Ste 300, 92056‑4674760‑730‑13034/1 (SP)

DC011153 SOUTH OCEANSIDE DENTAL GROUP2484 Vista Way Ste B, 92054‑5682760‑439‑03349/2 (SP)

DC033583 BRIGHT NOW DENTAL4170 Oceanside Blvd Ste 183, 92056‑6007760‑936‑000013/1

DC036283 WESTERN DENTAL SERVICES3125 Vista Way Ste 100, 92056‑3630760‑439‑002535/14 (SP)

DC040525 ANDREW K JOHN DDS INC2123 S El Camino Real, 92054‑6271760‑757‑77201/0 (KO SP)

DC058892 Oceanside Dental & Orthodontics4750 Oceanside Blvd Ste A15, 92056‑3064760‑466‑07761/0 (SP)

DC062220 Cassidy Smiles605 Cassidy St, 92054‑6033760‑433‑61111/0 (TA VI)

DC062791 Del Oro Smiles Dentistry Dental Group4171 Oceanside Blvd Ste 100C, 92056760‑283‑71802/0 (SP)

DC063544 Western Dental Services Inc3805 Mission Ave Ste A, 92058‑1873760‑439‑00267/0 (SP)

OntarioDC008852 HS GILL ARCHIBALD RANCH DENTAL3065 S Archibald Ave Ste B, 91761‑9000909‑923‑36401/0 (SP)

DC016585 EUCLID DENTAL CENTER2905 S Euclid Ave Ste D, 91762‑6684909‑391‑43002/0 (SP)

DC019519 ONTARIO VILLIAGE DENTAL533 W Holt Blvd Ste B, 91762‑3732909‑988‑19920/1 (SP)

DC022868 ONTARIO FAMILY DENTISTRY528 N Fern Ave, 91762‑3210909‑460‑95521/0 (SP)

DC024466 ONTARIO SMILES4190 E 4th St Ste C, 91764‑5263909‑532‑85184/0

DC037060 Assure Dental961 N Milliken Ave Ste 103, 91764‑5022909‑581‑77005/1 (AR CH FR KO 12 SP TA)

DC060741 Spectrum Dental Arts1049 W Philadelphia St, 91762‑6145909‑391‑23241/0 (HI SP)

DC062904 Beautiful Smiles126 W B St, 91762‑3503909‑984‑47461/0 (AR SP)

DC357001 MISSION DENTAL CARE941 W Mission Blvd Ste H, 91762‑6890909‑984‑78831/0 (CH HI 12 SP)

OrangeDC002804 GENTLE DENTAL ORANGE424 S Main St Ste H I J, 92868‑3828714‑639‑19225/3

DC004393 PREFERRED DENTAL CARE2022 W Chapman Ave, 92868‑2610714‑978‑33331/2 (CA HI JA SP)

DC004715 NEWPORT DENTAL1632 E Katella Ave Ste B, 92867‑5097714‑538‑231114/1 (SP VI)

DC008670 CALIFORNIA DENTAL GROUP OF ORANGE1502 E Collins Ave, 92867‑5934714‑288‑84640/1 (SP)

DC033008 ORANGE DENTAL GROUP235 S Tustin St, 92866‑2321714‑744‑00440/1

DC048221 TUSTIN PLAZA DENTAL GROUP1872 N Tustin St, 92865‑4605714‑637‑86620/0 (JA PE SP VI)

59

DeltaCare® USA

DC053655 Mayfair Dental1616 E Mayfair Ave, 92867714‑744‑81642/0 (SP)

DC056428 Orange Village Dentistry Dental Group2393 N Tustin St Ste A, 92865‑3714714‑453‑02154/0 (SP)

DC060675 Orange Sky Dental1916 N Tustin St, 92865‑4644714‑289‑50091/0 (HI SP)

DC061206 David M Datu DDS Inc1107 E Lincoln Ave Ste 201, 92865‑1945714‑998‑22411/0 (SP)

DC062008 Glow Dental294 S Tustin St, 92866‑2307714‑639‑41321/0 (SP)

DC063423 Glassell Dental245 N Glassell St Ste A, 92866‑1408714‑532‑56001/0 (SP)

DC282401 ORANGE HILL DENTAL3138 E Chapman Ave Ste A, 92869‑3722714‑639‑27032/0 (AM SP)

DC367801 TOWN & COUNTRY DENTAL1111 W Town And Country Rd Ste 33, 92868‑4667714‑285‑05053/0 (KM CA CH KO 12 SP TA VI)

OxnardDC018175 ROSE DENTAL GROUP2731 S Rose Ave Ste 101, 93033‑3964805‑483‑36582/0 (FinnishKO SP)

DC019926 IRAJ MOVAHHEDI DDS4225 Saviers Rd Ste 9, 93033‑7119805‑982‑82831/0 (SP)

DC043210 BRIGHT NOW DENTAL355 W Esplanade Dr, 93036‑1234805‑288‑308012/2

DC054727 Downtown Smile Center826 S A St, 93030‑7140805‑486‑39111/0 (AR AM SP)

DC057711 Western Dental Center455 S C St, 93030‑5917805‑483‑958630/0 (SP)

DC057728 Oxnard Dentistry1730 E Gonzales Rd, 93036‑3701805‑604‑99991/0 (SP)

DC060000 Oxnard Premium Dental451 W Gonzales Rd Ste 110, 93036‑0719805‑485‑23341/0 (AM RU SP)

DC063951 Oxnard Smiles Dentistry Dental Group1381 W Channel Islands Blvd, 93033‑4203805‑253‑17961/0 (SP)

DC063986 Oxnard Modern Dentistry Dental Group2150 N Rose Ave, 93036‑5058805‑604‑04494/0 (SP)

DC1C3601 DENTAL CARE OF OXNARD1350 W Gonzales Rd Fl 2, 93036‑3366805‑988‑58881/0 (AM SP TA)

DC395501 ESTHETIC SMILES1901 Solar Dr Ste 135, 93036‑0660805‑988‑22501/0 (AR JA SP)

PacoimaDC018258 PACOIMA FAMILY DENTAL CENTER9722 Laurel Canyon Blvd, 91331‑4106818‑897‑12341/0 (AR AM PE SP)

DC040985 WAEL H OBEID DDS INC13711 Van Nuys Blvd Ste 3, 91331‑3649818‑890‑26001/0 (AR SP)

Palm DesertDC022888 DESERT GATEWAY DENTAL GROUP34460 Monterey Ave Ste 100, 92211‑6008760‑610‑03586/1 (SP)

DC026260 PARC CENTER DENTAL77564 Country Club Dr Ste 350, 92211‑0450760‑772‑70821/1 (SP TA)

DC031853 SUNLIFE DENTAL GROUP73211 Fred Waring Dr Ste 201, 92260‑2888760‑568‑33681/0 (SP)

DC054281 Tellissi Family Dentistry72695 Highway 111 Ste A8, 92260‑3320760‑340‑21601/0 (FR GE SP)

DC062653 Desert Dental Associates72210 Highway 111 Ste E‑1, 92260‑2782760‑773‑21111/0

DC2C3701 DESERT CROSSING DENTAL GROUP72‑333 Highway 111 Ste B, 92260‑2790760‑674‑96666/1 (SP)

Palm SpringsDC036702 WESTERN DENTAL SERVICES555 S Sunrise Way Ste 400, 92264‑7894760‑322‑606138/7 (SP)

DC043816 ARMOUND MAHMOUDI DDS1921 E Tahquitz Canyon Way, 92262‑7001760‑325‑64801/0 (AM PE SP)

DC061629 Harmony Dental Practice333 S Canyon Dr Ste A, 92262‑7805760‑416‑02331/0 (KO)

DC199801 GENTLE DENTAL DESERT DENTAL1111 E Tahquitz Canyon Way Ste 210, 92262‑0102760‑904‑44822/2

PalmdaleDC000997 ANDRE KANARKI DDS1543 E Palmdale Blvd Ste B, 93550‑2000661‑274‑18661/0 (AM FR SP TA)

DC001732 HI DESERT DENTAL CENTER2205 E Palmdale Blvd, 93550‑1316661‑273‑13331/1 (PE RU SP)

DC017650 SIERRA COMMONS DENTAL GROUP755 W Rancho Vista Blvd, 93551‑3735661‑265‑78009/2 (SP)

DC020968 BRIGHT NOW DENTAL39345 10th St W Ste B, 93551‑3779661‑274‑806510/1 (12 SP)

DC025870 OASIS DENTAL CARE40008 10th St W Ste F 106, 93551‑3009661‑947‑27271/0 (SP)

DC026732 GATEWAY DENTAL GROUP38209 47th St E Ste E, 93552‑3113661‑236‑00467/0 (SP)

DC039637 WESTERN DENTAL SERVICES510 W Rancho Vista Blvd, 93551‑3737661‑273‑900037/3 (SP)

DC049984 ANTELOPE VALLEY DENTAL GROUP1037 E Palmdale Blvd Ste 203, 93550661‑272‑91818/0 (AR KO SP)

DC057459 Rwigema Dental Corporation3025 E Avenue S Ste A14, 93550‑2472661‑265‑76941/0 (FR SP TA)

DC062016 West AV Dental Group38745 Tierra Subida Ave Ste 150, 93551‑4567661‑272‑90915/0 (AR KO SP)

DC063249 Western Dental Services Inc2140 E Palmdale Blvd, 93550‑1202661‑265‑17001/0

Panorama CityDC013059 KOO DDS INC8215 Van Nuys Blvd Ste 220, 91402‑4836818‑782‑82610/2 (KO SP)

DC063003 Western Dental Services Inc8600 Van Nuys Blvd, 91402747‑201‑60144/0

DC063240 Western Dental Services Inc7942 Van Nuys Blvd, 91402‑6084818‑988‑31008/0 (SP)

DC357201 GARY KARSH DDS8628 Van Nuys Blvd Ste 200, 91402‑2913818‑895‑13210/1 (AR HE RU SP)

60

DeltaCare® USA

ParamountDC018649 DR CHEBBI DENTAL OFFICE16260 Paramount Blvd Ste G, 90723‑5448562‑633‑50701/0 (AR FR SP)

DC053010 Mahesh A Sejpal DDS8040 Alondra Blvd Ste E, 90723‑4355562‑633‑12131/0 (HI SP TA TA)

PasadenaDC000491 Western Dental Services Inc470 N Los Robles Ave, 91101‑1302626‑578‑120037/0

DC004502 PASADENA DENTAL CENTER766 N Lake Ave, 91104‑4557626‑808‑17170/1 (HI SP)

DC012908 NEWPORT DENTAL PASADENA290 N Hill Ave Ste 1, 91106‑1563626‑440‑02408/2 (SP)

DC016419 TINA GHOTANIAN DDS212 S El Molino Ave, 91101‑2906626‑792‑79000/1

DC017210 HASTINGS RANCH DENTAL GROUP255 N Rosemead Blvd, 91107‑3102626‑351‑01953/1 (SP)

DC018882 ROSE CITY DENTAL ARTS1855 E Colorado Blvd, 91107‑3554626‑440‑08010/1 (CA HI SP)

DC019231 LAKEVIEW DENTAL709 N Lake Ave, 91104‑4558626‑797‑89001/0 (AR FR GE SP)

DC021778 IBRAHIM RABADI DDS2281 E Washington Blvd, 91104‑1944626‑794‑26061/0 (AR AM RU TR)

DC022435 GENTLE CARE HEALTH SPA247 N Lake Ave, 91101‑1828626‑405‑29220/1 (AR AM SP)

DC028398 FAIR OAKS FAMILY DENTAL929 N Orange Grove Blvd, 91103‑3354626‑449‑37002/2 (AM SP)

DC040863 PASADENA FAM COSMETIC & IMPLANT DENTISTRY800 Fairmount Ave Ste 100, 91105‑3158626‑304‑30041/0 (AR AM CH KO 12 RU SP TA)

DC055985 Sona Asatryan301 S Fair Oaks Ave Ste 206, 91105‑2536626‑431‑26541/0 (AM SP)

DC059117 The Smile Agency1175 E Green St, 91106‑2505626‑270‑01002/0 (SP)

DC059831 Art of Dentistry859 N Fair Oaks Ave Ste 120, 91103‑3078626‑765‑97581/0 (AM)

DC061015 Bright Smile Dental2245 E Colorado Blvd Ste 201, 91107‑3651626‑449‑33671/0 (KO SP)

DC061219 Genesis Dental Esthetics200 S El Molino Ave Ste 2, 91101‑2985626‑314‑35501/0 (AM RU SP)

DC272401 PASADENA DENTAL ASSOCIATES1302 N Altadena Dr, 91107‑1430626‑797‑67782/0 (CH SP)

DC316601 DAVID WYNDHAMSMITH DDS1092 E Green St, 91106626‑795‑93282/0 (AM KO 12 SP VI)

PerrisDC022885 CROSSING DENTAL GROUP3150 Case Rd Bldg C, 92570‑5552951‑345‑438610/2 (SP)

DC032981 GENTLE DENTAL PERRIS2560 N Perris Blvd Ste F1, 92571‑3226951‑657‑64662/1

DC061383 Western Dental Services Inc1688 N Perris Blvd Ste G1, 92571‑4744951‑940‑577130/0 (SP)

Pico RiveraDC000013 FAMILY DENTISTRY8532 Whittier Blvd, 90660‑2520562‑695‑52511/0 (HI SP)

DC021700 CORD FAMILY DENTAL CARE9400 Whittier Blvd, 90660‑2833562‑949‑25262/0 (SP)

DC025067 BRIGHT SMILE DENTAL8819 Whittier Blvd Ste 102, 90660‑2673562‑699‑10001/0 (SP)

DC039985 BRIGHT NOW DENTAL8963 Washington Blvd, 90660‑3728562‑566‑100415/1 (SP)

DC320601 ASHOKKUMAR MEHTA DDS9514 Whittier Blvd, 90660‑2835562‑942‑23450/1 (HI SP)

DC367501 DANNY MUDITAJAYA DDS9123 Slauson Ave, 90660‑4522562‑949‑01774/0 (CH IN SP)

PlacentiaDC004485 NAOMI AND ANTHONY WONG DDS415 W Chapman Ave, 92870‑5905714‑223‑20210/1 (CH SP)

DC016013 PLACENTIA FAMILY DENTISTRY1525 N Placentia Ave Ste H, 92870‑2334714‑528‑00891/0 (CH SP VI)

DC049420 COSMETIC AND DENTAL IMPLANT CENTER1858 N Placentia Ave, 92870‑2303714‑577‑90702/0 (KO SP VI)

DC058370 Gentle Dental Placentia620 N Rose Dr Ste B, 92870‑7513714‑294‑71345/0 (SP)

PomonaDC001718 BELLA MANCHANDIA DDS551 E Holt Ave, 91767‑5623909‑622‑86001/0 (HI SP)

DC005493 FAMILY DENTAL CLINIC2280 S Garey Ave, 91766‑5645909‑364‑06332/1 (SP)

DC011143 PEARL DENTAL CARE2407 Valley Blvd Ste C, 91768‑2719909‑839‑10040/1 (HI SP)

DC011786 KENT HUNG DMD520 E Foothill Blvd Ste B, 91767‑1200909‑624‑17810/1 (SP)

DC034442 ANGELIC DENTISTRY847 Philadelphia St, 91766‑5714909‑627‑41771/0 (RO RU SP)

DC056723 Pomona Dentistry Dental Group2071 Rancho Valley Dr Ste 140, 91766‑7105909‑374‑18153/0

DC057159 Armen Mardirosian DDS Inc180 E Mission Blvd Ste A, 91766‑1843909‑623‑52781/0 (AM SP)

DC348001 DONALD HODSON DDS1956 Hill Blvd, 91767‑3620909‑621‑58481/0 (FR PE SP)

DC357101 POMONA DENTAL GROUP850 Hill Blvd, 91767‑5308909‑626‑35411/0 (KO SP)

Port HuenemeDC059054 All Care Dental607 W Channel Islands Blvd, 93041‑2136805‑985‑55001/0

PortervilleDC036350 WESTERN DENTAL SERVICES1213 W Henderson Ave, 93257‑1454559‑306‑310031/5 (SP)

PowayDC001867 A POWAY DENTAL GROUP12921 Pomerado Rd, 92064‑5325858‑679‑49490/1

DC007273 POWAY FAMILY DENTAL GROUP13616 Poway Rd Ste 100, 92064‑6548858‑391‑93001/1 (SP)

DC009629 POMERADO FAMILY DENTAL GROUP15706 Pomerado Rd Ste 201, 92064‑2033858‑674‑52521/0 (HI SP)

61

DeltaCare® USA

DC039641 WESTERN DENTAL SERVICES12649 Poway Rd, 92064‑4415858‑486‑610030/8

Rancho CucamongaDC004956 JIA LEE DDS9477 Haven Ave, 91730‑5844909‑989‑55980/1 (CH SP)

DC014115 WINERY ESTATE DENTAL GROUP7369 Day Creek Blvd Ste F103, 91739‑8020909‑646‑79025/3 (SP)

DC018520 GINA BARRAMEDA DMD8351 Rochester Ave Ste 109, 91730‑3998909‑466‑53520/2 (TA TA)

DC022886 MONET DENTAL GROUP12455 Victoria Gardens Ln Ste 190, 91739‑7534909‑646‑30577/2 (SP)

DC047337 RANCHO CUCAMONGA SMILES DENTISTRY GROUP7319 Milliken Ave Ste 110, 91730‑6794909‑945‑36507/0 (SP)

DC048663 HORIZON DENTAL PRACTICE9353 Fairway View Pl Ste 200, 91730‑0962909‑987‑99332/0 (AR SP)

DC049527 GENTLE DENTAL FOOTHILL8880 Foothill Blvd Ste 5, 91730‑7198909‑945‑05954/0

DC057601 Terra Vista Dental Care7211 Haven Ave Ste D, 91701‑6064909‑256‑84841/0 (HI SP)

DC059654 Sarah Yang DDS9310 Baseline Rd, 91701‑5821909‑989‑18681/0 (CH)

DC060120 Talent Dental10590 Town Center Dr Ste 180, 91730‑0364909‑313‑00441/0 (AR SP)

DC060376 A Plant Dental Center7333 Hellman Ave, 91730‑1302909‑483‑06001/0 (CH KO SP)

DC063175 Ocean Dental Group9349 Foothill Blvd Ste B, 91730‑3567909‑980‑63637/0 (AR FR KO 12 SP TR)

DC063384 All About Smile Dental Group10630 Town Center Dr Ste 131, 91730‑8600909‑987‑66432/0 (CA HI JA 12 SP)

DC063827 Ponderosa Dental Group8463 Haven Ave, 91730‑3845909‑481‑00252/0

DC117701 STAR DENTAL GROUP12729 Foothill Blvd Ste A, 91739‑9334909‑899‑87573/0 (SP)

DC390301 RANCHO CUCAMONGA DENTAL CARE10470 Foothill Blvd Ste 126, 91730‑6945909‑989‑78881/0 (AM 12 SP VI)

DC3C7001 GHAZAL DENTAL CORPORATION10797 Foothill Blvd, 91730‑3858909‑581‑08886/2 (SP)

Rancho MirageDC022862 RANCHO MIRAGE DENTAL GROUP71817 Highway 111 Ste 1, 92270‑4446760‑340‑51553/2 (SP)

Rancho Palos VerdesDC057033 RANCHO PALOS VERDES DENTISTRY28901 S. Western Avenue Suite135, 90275310‑750‑24704/0

Rancho Santa MargaritaDC3C6501 RANCHO DENTAL GROUP30592 Santa Margarita Pkwy Ste D, 92688‑5802949‑766‑57407/0 (SP)

Rch CucamongaDC014841 BRIGHT NOW DENTAL11561 Foothill Blvd Ste 104, 91730‑3999909‑483‑781119/3 (HI SP)

DC047480 WESTERN DENTAL SERVICES INC8678 19th St Ste 140, 91701‑4559909‑257‑201356/0

DC1C7401 RANIA REFAAT DDS7388 Carnelian St Ste C, 91730‑1160909‑989‑17581/0 (AR SP)

RedlandsDC005437 REDLANDS DENTAL GROUP422 Orange St, 92374‑3206909‑792‑75008/1 (SP)

DC010256 ALEJANDRA GALINDO MAGALLANES321 Cajon St, 92373‑5901909‑888‑36880/1 (SP)

DC016012 BRIGHT NOW DENTAL1285 Alabama St, 92374‑2813909‑793‑577710/1 (RO SP)

DC028395 ELITE DENTAL ASSOCIATES245 Terracina Blvd Ste 207A, 92373‑4869909‑798‑41112/0

DC044332 WESTERN DENTAL SERVICES INC1715 W Redlands Blvd Ste B, 92373‑9601909‑801‑814039/14 (HI SP)

DC061112 Tri City Family Dental1402 Industrial Park Ave, 92374‑4517909‑798‑57771/0

DC062409 Rana Dentistry1748 E Lugonia Ave Ste 126, 92374‑2732909‑794‑58601/0 (HI SP)

Redondo BeachDC041128 BEACH CITY DENTAL GROUP1509 Hawthorne Blvd Ste 102, 90278‑3957310‑376‑52524/1 (SP)

DC055010 Bayside Dental Care1884 1/2 S Pacific Coast Hwy, 90277‑6117310‑792‑46271/0

DC126601 GALLERIA DENTAL CARE2772 Artesia Blvd Ste 103, 90278‑3370310‑370‑15862/0 (FR IT SP)

ResedaDC004480 SMILE MASTERS DENTAL CENTER17703 Vanowen St, 91335‑5602818‑609‑00091/0 (AM FR HI SP)

DC012592 VALLEY DENTAL CENTER19231 Victory Blvd Ste 357, 91335‑6354818‑785‑54450/1 (SP)

DC027180 HENIDE ARIAS DDS19231 Victory Blvd Ste 252, 91335‑6341818‑881‑89400/1 (SP)

DC040015 RESEDA DENTAL GROUP18437 Saticoy St Ste 1, 91335‑2911818‑344‑83381/0 (AM SP)

DC042340 ESTHITIC SMILE19231 Victory Blvd Ste 455, 91335‑6366818‑344‑49291/0 (AR AM HU RU SP TA)

DC042499 MONICA HERDOIZA DDS6915 Reseda Blvd Unit 3, 91335‑4246818‑881‑68441/0 (SP)

DC043062 RUBTSOV DDS INC19301 Saticoy St Ste D, 91335‑2358818‑772‑42220/1 (RU SP)

DC043476 BRIGHT NOW DENTAL RESEDA19361 Saticoy St Ste A, 91335‑2360818‑739‑102820/1

DC059405 Smile Brite Dental18909 Sherman Way, 91335818‑345‑13431/0 (FR HE SP)

DC061209 Canby Dental18440 Sherman Way, 91335‑4218818‑343‑40241/0 (SP)

RialtoDC004514 RIALTO DENTAL GROUP1629 S Riverside Ave, 92376‑7707909‑421‑22255/2 (SP)

DC022887 METTA SURYA DDS FAMILY DENTISTRY1734 N Riverside Ave Ste 3, 92376‑8058909‑875‑12791/0 (IN SP)

62

DeltaCare® USA

DC047466 WESTERN DENTAL SERVICES INC260 W Foothill Blvd, 92376‑5048909‑546‑136673/0

DC056287 Soyoung Kim DDS INC1374 W Foothill Blvd Ste 2E, 92376909‑874‑74441/0 (KO)

DC063210 Atef E Hana DDS INC2836 W Rialto Ave Ste A, 92376‑6816909‑820‑94541/0 (AR SP)

DC063425 Luxe Dental Studio1733 N Riverside Ave, 92376‑8062909‑875‑25481/0 (SP)

DC117501 DRS EBENEZER AND RACHEL JOHNSON DDS INC511 S Riverside Ave, 92376‑7027909‑820‑22742/0 (SP)

DC166001 DENTAL CARE OF RIALTO INC1817 N Riverside Ave, 92376‑8069909‑879‑10242/0 (CH 12 PT SP)

RiversideDC000767 NEWPORT DENTAL3724 La Sierra Ave Ste F1, 92505‑3066951‑688‑24007/3 (SP VI)

DC006976 GENTLE DENTAL RIVERSIDE3630 Central Ave Ste 6, 92506‑5903951‑682‑17205/1

DC006983 GENTLE DENTAL RIVERSIDE10168 a Ave, 92503‑5302951‑352‑97475/1

DC010631 JULIA ROMITAN DDS INC6860 Brockton Ave Ste 12, 92506‑3816951‑684‑99171/0 (GE RO SP)

DC012718 PARISSA DJAFARI DDS6900 Brockton Ave Ste 2, 92506‑3801951‑682‑22451/0 (FR SP)

DC014141 GROVE DENTAL GROUP8735 Trautwein Rd, 92508‑9474951‑776‑133014/1 (SP)

DC014243 REZA RAJABI DMD7776 Limonite Ave, 92509‑5314951‑360‑06961/1 (SP)

DC014338 GATEWAY DENTAL GROUP10286 a Ave, 92503‑5357951‑359‑52009/3 (SP)

DC015584 CANYON SPRINGS DENTAL GROUP2878 Campus Pkwy Ste 1, 92507‑0945951‑571‑00117/1 (SP)

DC017776 ANWAR NASSER DDS6326 Mission Blvd Ste B, 92509‑4121951‑367‑16661/0 (AR SP)

DC024651 ORANGECREST FAMILY DENTAL PRACTICE19348 Van Buren Blvd Ste 117, 92508‑9158951‑789‑99051/0 (SP)

DC025621 REGAL DENTISTRY3950 Pierce St Ste L, 92505‑3809951‑688‑00822/0 (AM CA HR 12 RU SP TA)

DC037609 RAINCROSS DENTAL7028 a Ave Ste A, 92506‑4157951‑367‑13450/1 (SP VI)

DC042936 ARLANZA FAMILY HEALTH CENTER8856 Arlington Ave, 92503‑1365951‑710‑397012/0 (SP)

DC046532 TYLER DENTAL CENTER4080 Tyler St Ste D, 92503‑3432951‑359‑01491/0 (HI SP)

DC053111 WESTERN DENTAL SERVICES3485 Madison St, 92504‑3716951‑688‑710577/0 (SP VI)

DC055006 WESTERN DENTAL SERVICE INC3880 Chicago Ave, 92507‑5354951‑643‑610048/0 (SP)

DC056751 Kalyani DDS Inc17024 Van Buren Blvd Ste B, 92504‑5921951‑892‑00221/0 (HI SP)

DC057746 Jurupa Springs Family Dental8880 Limonite Ave, 92509‑5021800‑881‑03931/0 (GE SP)

DC058013 Palm Dental Group6862 Palm Ave, 92506‑2812951‑683‑54901/0 (KO SP)

DC058019 Riverside Plaza Dentistry Dental Group3602 Riverside Plaza Dr. Suite 101, 92506951‑228‑95763/0 (SP)

DC059209 Western Dental Services Inc4024 12th St, 92501‑3561951‑784‑063633/0

DC060085 Riverwalk Dental Spa11695 Slate Ave Ste 200, 92505‑5197951‑353‑00502/0 (SP VI)

DC060887 My Riverside Dentist6339 Brockton Ave, 92506‑2031951‑369‑35971/0 (SP)

DC062755 Young Kwun Kim6859 Magnolia Ave Ste 2, 92506‑2866951‑682‑08101/0

DC063272 Dental Specialists of Riverside10181 Magnolia Ave, 92503‑3444951‑689‑07014/0 (RU SP)

DC172501 VIVIAN KWON DDS2955 Van Buren Blvd Ste H4, 92503‑5675951‑689‑85441/0 (KO SP VI)

DC267501 DENTAL ASSOCIATES OF RIIVERSIDE3487 Central Ave, 92506‑2115951‑369‑10011/1 (4 KO SP TH)

DC2C0201 ARLINGTON DENTAL3297 Arlington Ave Ste 101, 92506‑3250951‑683‑60558/3 (SP)

Rolling HillsDC3C3801 PENINSULA DENTAL ARTS550 Deep Valley Dr Ste 347, 90274‑7603310‑377‑95750/1 (SP)

RosemeadDC002496 STEVEN HOU DDS2240 San Gabriel Blvd, 91770‑3644626‑288‑83571/0 (12 SP)

DC055325 Glenrose Dental8951 Glendon Way Ste 1, 91770‑1892626‑288‑76671/0 (CA SP)

DC055576 Jun and Shan Dental Service Inc2111 San Gabriel Blvd Ste I, 91770‑3600626‑280‑49762/0 (CA CH 12 SP)

DC056529 Chang Family Dentistry8038 Garvey Ave Ste B, 91770‑2483626‑571‑70001/0 (CA 12 SP)

S El MonteDC056404 DURFEE DENTAL OFFICE2001 Santa Anita Ave Ste 204, 91733‑3441626‑443‑39151/0 (12 SP VI)

San BernardinoDC007367 SOUTHLAND DENTAL GROUP399 E Highland Ave Ste 120, 92404‑3812909‑881‑06451/0 (AR SP)

DC011183 ARROWHEAD FAMILY DENTISTRY407 S E St, 92401‑2012909‑889‑33000/1 (AR HI SP)

DC011723 SURE SMILE DENTAL OFFICE275 E 9th St Ste L, 92410‑4400909‑381‑55550/2 (HI SP)

DC012744 HUB PLAZA DENTAL GROUP1047 Harriman Pl Ste B, 92408‑4203909‑796‑67006/3 (SP)

DC015305 AHMED NAJI DDS1799 N Waterman Ave Ste E, 92404‑5107909‑883‑82821/0 (AR SP)

DC015306 IAN SHWARTZMAN DDS330 N D St Ste 360, 92401‑1524909‑475‑55651/0 (SP)

DC025852 MGO DENTAL654 W 4th St Ste A, 92410‑3216909‑386‑36500/1 (AR FR SP)

63

DeltaCare® USA

DC036585 WESTERN DENTAL SERVICES1199 N E St, 92410‑3507909‑388‑241555/10 (SP)

DC049131 INLAND FAMILY COMMUNITY HEALTH CENTER665 N D St, 92401‑1109909‑708‑81683/0 (GE 4 SP)

DC053679 Sonrisas Dental Studio570 S Mount Vernon Ave Ste E, 92410909‑219‑52291/0 (SP)

DC054399 Western Dental Services Inc2094 E Highland Ave, 92404‑4626909‑388‑242039/0

DC057649 Orange Show Dental Group & Orthodontics290 W Orange Show Rd Ste 105, 92408‑3345909‑567‑22231/0 (SP)

DC063435 Carlos L Torres DDS290 W Orange Show Rd Ste 102, 92408‑3345951‑677‑21151/0 (SP)

DC063927 All Smile Dental Group2015 N Waterman Ave Ste B, 92404‑4810909‑713‑20771/0 (PE SP)

DC193801 CITRUS DENTAL242 E Airport Dr Ste 100, 92408‑3408909‑890‑00501/0 (SP)

DC1C7601 INLAND DENTAL CENTER362 E Vanderbilt Way, 92408‑3593909‑384‑11113/1 (KO SP TA)

DC396401 WATERMAN DENTAL CENTER1428 N Waterman Ave Ste A, 92404‑5382909‑889‑11111/0 (SP)

San ClementeDC004795 SAN CLEMENTE DENTAL GROUP943 Avenida Pico Unit A, 92673‑3914949‑366‑95554/3 (SP)

DC009035 TALEGA DENTAL GROUP1151 Puerta Del Sol Ste A, 92673‑6311949‑369‑83000/1 (SP)

DC012354 ARTISTIC DENTISTRY439 N El Camino Real Ste E, 92672‑4700949‑366‑11771/0 (PE SP)

DC037851 SAN CLEMENTE DENTAL ASSOC638 Camino De Los Mares Ste C140, 92673‑4813949‑234‑05001/0 (SP)

DC059737 Seascape Cosmetic and Implant Dentistry675 Camino De Los Mares Ste 304, 92673‑2837949‑496‑50011/0

San DiegoDC000752 Dental Arts of Coronado Avenue2987 Coronado Ave Ste A, 92154‑2180619‑429‑59591/0 (SP)

DC001895 PACIFIC DENTAL9330 Mira Mesa Blvd Ste B, 92126‑4822858‑695‑31771/1 (SP VI)

DC002826 NASER OSTAD DDS12330 Carmel Mountain Rd Ste C4, 92128‑4654858‑485‑05552/0 (SP)

DC003121 SUNSHINE DENTISTRY4230 30th St, 92104‑1312619‑282‑10071/0 (SP TA)

DC004767 GENTLE DENTAL SORRENTO VALLEY11230 Sorrento Valley Rd Ste 130, 92121‑1338858‑458‑91262/1 (SP)

DC007133 WESTVIEW DENTAL OFFICE13350 Camino Del Sur Ste 6, 92129‑4473858‑484‑99770/1 (HI JA SP TA)

DC010687 COAST DENTAL CARE6585 El Cajon Blvd, 92115‑2706619‑265‑00720/2 (SP)

DC012742 TIERRASANTA DENTAL GROUP10405 Tierrasanta Blvd, 92124‑2603858‑492‑93007/2 (SP)

DC014130 COSMETIC AND FAMILY DENTISTRY9636 Tierra Grande St Ste 105, 92126‑6502858‑549‑45111/0 (AM)

DC017306 GENTLE DENTISTRY4765 Carmel Mountain Rd Ste 205, 92130‑6657858‑350‑74001/0 (AR CH GE SP TA)

DC018955 PEARL COSMETIC‑FAMILY DENTISTRY13522 Sabre Springs Pkwy Ste 201, 92128‑4687858‑513‑17470/1

DC020249 BERNARDO HEIGHTS DENTAL GROUP15731 Bernardo Heights Pkwy Ste 101, 92128‑3156858‑674‑68136/1 (SP)

DC021704 RAY DERAKSHAN DMD11134 Rancho Carmel Dr Ste 103, 92128‑4671858‑485‑10101/0

DC022122 WILLIAM CARLO DMD9040 Friars Rd Ste 535, 92108‑5863619‑285‑09501/0 (SP)

DC023305 ADVANCED DENTISTRY4320 Genesee Ave Ste 101, 92117‑4900858‑277‑81000/1 (IT SP)

DC031631 SMILE SAN DIEGO2650 Camino Del Rio N Ste 102, 92108‑1630619‑298‑05210/1 (KO SP TA VI)

DC034682 DR ELLIES GENTLE DENTISTRY2020 Camino Del Rio N Ste 101, 92108‑1542619‑542‑18000/1 (AR SP)

DC035574 OASIS SMILES11611 Rancho Bernardo Rd Ste 103, 92127‑1412858‑592‑95001/0

DC037980 MESA FAMILY DENTAL5450 Clairemont Mesa Blvd Ste C, 92117‑2360858‑503‑67891/0

DC038328 ARVINDA REDDY K DDS INC5440 Morehouse Dr Ste 1800, 92121‑6705858‑433‑87981/0 (LO SP)

DC039542 EDWARD FARAJZADEH DDS3867 Clairemont Dr, 92117‑5831858‑581‑65350/1

DC040427 MESA DENTAL7625 Mesa College Dr Ste 100, 92111‑5343858‑514‑42900/1 (SP TA)

DC040744 AMERICAN DENTAL CLINIC5382 Clairemont Mesa Blvd, 92117‑2213858‑277‑66201/0 (TA TA)

DC041671 PRIME DENTAL CARE10717 Camino Ruiz Ste 150, 92126‑2362858‑831‑92881/0 (PE SP)

DC042861 A STREET DENTAL ARTS450 A St Ste 200, 92101‑4217619‑233‑33381/0 (SP)

DC044371 MISSION VALLEY DENTISTS5638 Mission Center Rd Ste 107, 92108‑4348619‑220‑01599/1 (SP)

DC045672 STONECREST DENTAL GROUP3737 Murphy Canyon Rd Ste C2, 92123‑4454858‑694‑07907/0 (SP TA)

DC046483 WESTERN DENTAL SERVICES4123 University Ave, 92105‑1418619‑521‑003338/0

DC046680 WESTERN DENTAL SERVICES2948 University Ave, 92104‑2934619‑294‑466137/0 (SP)

DC049357 CLAIRMONT SMILES DENTISTRY AND ORTHO5675 Balboa Ave, 92111‑2705858‑268‑01107/0

64

DeltaCare® USA

DC050872 WESTERN DENTAL SERVICES3802 Clairemont Mesa Blvd, 92117‑2712858‑273‑839035/0 (SP)

DC054458 PB Smiles Dentistry Dental Group1975 Garnet Ave Ste E, 92109‑3594858‑866‑08085/0 (SP)

DC054481 Kensington Dental Group4142 Adams Ave Suite 104, 92116‑2508619‑326‑01577/0 (SP)

DC056205 Pacific Highlands Dentistry Dental Group5965 Village Way Suite E‑206, 92130‑2475858‑900‑35416/0 (SP)

DC056447 Affinity Dental of Hillcrest3330 3rd Ave Ste 400, 92103‑5639619‑291‑87501/0 (SP TA)

DC056531 Downtown SD Modern Dentistry Dental Group435 4th Ave, 92101‑6234619‑850‑25504/0

DC056532 East Village Dental Group1455 G St, 92101‑7309619‑324‑49816/0

DC057406 Extreme Smile Makeover1450 Frazee Rd Ste 209, 92108‑4342619‑574‑66781/0 (SP)

DC057790 Bay Park Dentistry Dental Group2995 Clairemont Dr Ste A, 92117‑6766858‑200‑08276/0

DC058437 Dr Zak San Diego Dental Care & Orthodontics5625 Ruffin Rd Ste 200, 92123‑6392858‑569‑965110/0 (AR AM FR RO RU SP TA)

DC058878 Toma & Petros DDS Inc3737 Moraga Ave Ste B311, 92117‑5361858‑483‑20931/0 (SP)

DC060126 Coastal Dental Arts1230 Columbia St Ste 870, 92101‑8539619‑858‑80801/0

DC060128 University Avenue Dental Group6324 University Ave, 92115‑5813619‑582‑42241/0 (AR SP TR)

DC061162 College Grove Dentistry Dental Group3408 College Ave, 92115‑7134619‑363‑38811/0

DC061713 San Diego Family Care7011 Linda Vista Rd, 92111‑6307858‑810‑87293/0 (SP VI)

DC062180 San Diego Advanced Dental Centers1901 4th Ave Ste 300, 92101‑2381619‑236‑79593/0 (SP)

DC062181 Fill Dental Group2845 Nimitz Blvd Ste A, 92106‑2387619‑223‑81791/0 (SP TA)

DC062456 Bright Now! Dental‑Carmel Plaza Dental11738 Carmel Mountain Rd Ste 170, 92128‑4635858‑675‑11807/0

DC062624 Serra Mesa Modern Dentistry Dental Group3268 Greyling Dr, 92123‑2230858‑617‑06201/0 (SP)

DC062757 SABRE SPRINGS DENTISTRY11385 Poway Rd Ste 103, 92128‑5600858‑486‑86111/0 (KO SP)

DC062877 SmilePlus Dentistry ‑ Mission Valley1333 Camino Del Rio S Ste 202, 92108‑3520619‑260‑49903/0 (AR SP)

DC063501 San Ysidro Health King Chavez Health Center950 S Euclid Ave, 92114‑6201619‑662‑41002/0

DC063535 Reesor Dental Group PC11968 Bernardo Plaza Dr, 92128‑2538858‑521‑00002/0 (AR SP)

DC063577 Dr Natalya Carmichael9728 Carmel Mountain Rd Ste B, 92129‑2849858‑484‑25601/0 (RU SP TA TR)

DC063625 Serenity Dental Group12396 World Trade Dr Ste 208, 92128‑3788858‑673‑10001/0 (SP)

DC063984 Rancho Dental Care9912 Carmel Mountain Rd Ste B, 92129‑2808858‑538‑91821/0 (SP)

DC0C2001 SUNSHINE DENTAL OFFICE9888 Carmel Mountain Rd Ste B, 92129‑2807858‑780‑88701/0 (CH TA)

DC171301 GLENN E HALDY DDS3670 Clairemont Dr Ste 14, 92117‑5961858‑273‑05401/0 (SP)

DC252901 STEPHEN BARAL DDS5189 Clairemont Mesa Blvd, 92117‑1446858‑277‑39001/0

DC377901 MARK RIEDLER DDS4167 Ohio St, 92104‑1926619‑281‑66352/0 (SP)

DC385601 BERNARDO DENTAL OFFICE16466 Bernardo Center Dr Ste 185, 92128‑2522858‑676‑18451/0 (HI SP TA)

DC3C6901 MISSION BAY DENTAL1324 Garnet Ave, 92109‑3011619‑275‑27501/0 (SP)

San DimasDC011722 SAN DIMAS DENTAL OFFICE923 W Arrow Hwy, 91773‑2420909‑592‑55997/0 (SP)

DC035071 SUNSHINE SMILE DENTAL1033 W Arrow Hwy, 91773‑2422909‑447‑70921/0 (SP)

DC045957 ALEMAN SUNRISE DENTAL1111 W Covina Blvd Ste 240, 91773‑3205909‑305‑23241/0 (SP)

DC061799 Dr Zak Plaza Dental Office1120 Via Verde, 91773‑4401909‑599‑24449/0 (AR AM FR HE RO RU SP TA)

San FernandoDC002380 TOOTH FAIRY DENTAL556 S Brand Blvd, 91340‑4002818‑365‑30041/0 (SP TA)

DC019218 CALIFORNIA DENTAL2040 Glenoaks Blvd Ste F, 91340‑1662818‑361‑38891/0 (AM SP)

DC020926 HEAVENLY DENTAL321 N Maclay Ave Ste A, 91340‑2945818‑837‑97440/2 (SP)

DC052867 Western Dental Services Inc1101 Truman St Ste A, 91340‑3254818‑898‑143342/0 (SP)

DC055402 Fawzy Tadros DDS774 N Maclay Ave Ste A, 91340‑2143818‑403‑64361/0 (AR FR SP)

San GabrielDC001455 DEL MAR FAMILY DENTAL702 S Del Mar Ave Ste A, 91776‑2440626‑287‑97810/1 (AR AM SP)

DC001457 DR. M LWIN1739 S San Gabriel Blvd, 91776‑3927626‑288‑57770/2 (CA 12 SP)

DC001807 SAN GABRIEL FAMILY DENTISTRY531 W Las Tunas Dr Ste B, 91776‑1166626‑281‑16281/0 (12 SP)

DC013313 SAN GABRIEL VALLEY FAMILY DTL6503 Rosemead Blvd, 91775‑1936626‑286‑21561/0 (CA 4 12 SP TH VI)

DC023902 SAN GABRIEL DENTAL GROUP6909 Rosemead Blvd, 91775‑1412626‑286‑86000/2 (CA 12 SP)

65

DeltaCare® USA

DC038500 HAI‑SOU CHEN DDS301 W Valley Blvd Ste 222, 91776‑3759626‑573‑56371/0 (CA 12)

DC058443 Sunday Dental1434 S San Gabriel Blvd, 91776‑3656626‑571‑82101/0 (CH SP)

DC062710 Agape Dental314 W Valley Blvd, 91776‑3727626‑458‑34102/0 (CH IN SP VI)

San JacintoDC024844 SAN JACINTO SMILES1643 S San Jacinto Ave Ste 100‑101, 92583‑5181951‑654‑77446/1 (SP)

DC035557 SAN JACINTO DENTAL GROUP701 W Esplanade Ave Ste KL, 92582‑4540951‑654‑34241/0 (HI SP)

San Juan CapistranoDC036579 SAN JUAN DENTAL GROUP31897 Del Obispo St Ste 100, 92675‑3207949‑487‑02841/0 (IT PE SP)

DC055252 Paradise Dental31726 Rancho Viejo Rd Ste B109, 92675949‑481‑21211/0 (SP)

DC057737 Beautiful Smilez Dentistry31734 Rancho Viejo Rd Ste D, 92675‑2782949‑496‑29301/0 (GE SP)

DC0C9701 MEHRVARZI MEHRDOKHT DENTAL CORP31952 Camino Capistrano Ste C14 And Ste C16, 92675‑3229949‑240‑68881/0

San Luis ObispoDC007574 DISBELL MANSILLA DDS862 Meinecke Ave Ste 200, 93405‑3704805‑547‑70103/1 (IT 12 PT SP)

DC032053 RICUCCIO NEGOM DDS735 Tank Farm Rd Ste 170, 93401‑7071805‑549‑90000/1 (SP)

DC058619 R&R Dental Care973 E Foothill Blvd #101, 93405‑1311805‑544‑94408/0 (SP)

San MarcosDC003532 ANNA DURKIN DDS1344 E Mission Rd Ste C, 92069‑3038760‑740‑00701/0 (RU SP)

DC009368 SAN MARCOS DENTAL GROUP709 Center Dr Ste 101, 92069‑2502760‑746‑20454/3 (SP)

DC019237 WOODLAND DENTAL GROUP979 Woodland Pkwy Ste 100, 92069‑2282760‑745‑11000/1 (SP VI)

DC023810 SMILES OF SAN MARCOS630 Nordahl Rd Ste D, 92069‑3541760‑480‑17501/0 (HI SP)

DC024235 GRAND PLAZA DENTAL GROUP137 S Las Posas Rd Ste 250, 92078‑2470760‑752‑70001/0

DC033585 BRIGHT NOW! DENTAL SAN MARCOS752 S Rancho Santa Fe Rd Ste 752, 92078‑3935760‑936‑000215/1

DC041200 WESTERN DENTAL SERVICES INC169 S Rancho Santa Fe Rd, 92078‑2501760‑916‑959533/9 (SP)

DC044397 LAS POSAS DENTAL PRACTICE145 S Las Posas Rd Ste 162, 92078‑2419760‑736‑42472/2 (SP)

DC044944 BUSINESS PARK DENTAL960 W San Marcos Blvd Ste 120, 92078‑1125760‑736‑43000/0

DC058889 Rancho Palomar Dental Care637 S Rancho Santa Fe Rd, 92078‑3973760‑744‑81991/0 (SP)

DC059186 Babak Shahrokh DMD Inc365 S Rancho Santa Fe Rd Ste 105, 92078‑2338760‑471‑95601/0 (AR SP TA)

DC062767 Sun Smile Dental1582 W San Marcos Blvd Ste 201, 92078‑4081760‑744‑13002/0 (CH 12 SP)

San PedroDC019925 SAN PEDRO DENTAL697 S Gaffey St, 90731‑3026310‑548‑127317/0 (SP VI)

DC039543 SAN PEDRO FAMILY DENTIST204 N Pacific Ave, 90731‑2016310‑832‑88001/0 (KO SP)

DC044347 SAN PEDRO DENTAL CARE520 W 7th St, 90731‑3116310‑832‑53610/1 (SP)

San YsidroDC000375 San Ysidro Dental Care2004 Dairy Mart Rd Ste 120, 92173‑1882619‑428‑24361/0 (SP)

DC063524 San Ysidro Health San Ysidro Health Center4004 Beyer Blvd, 92173‑2007619‑662‑41003/0 (SP TA)

Santa AnaDC007333 NANDINI MURTHY DDS2723 N Bristol St Ste D7, 92706‑1419714‑569‑00210/1

DC011738 MY DENTIST2001 W 17th St, 92706‑2322714‑547‑44441/0 (SP)

DC013085 DENTAL 4102 E 4th St Fl 2, 92701‑4602714‑558‑14641/0 (FR SP)

DC013087 PRAKASH PATEL DDS2637 N Grand Ave, 92705‑8707714‑288‑99800/1 (SP)

DC021406 BRIGHT NOW DENTAL1601 W 17th St Ste G, 92706‑3340714‑567‑925513/0 (SP)

DC022140 ORANGE COAST DENTAL1717 Old Tustin Ave Unit A, 92705‑7879714‑835‑91881/0 (SP)

DC026173 Assure Dental Family Care940 N Grand Ave, 92701‑4208714‑541‑94942/0 (CA HE KO 12 SP)

DC030578 SWEET TOOTH DENTAL301 1/2 N Main St, 92701‑4852714‑547‑66000/2 (SP)

DC042516 WESTERN DENTAL SERVICES500 N Main St, 92701‑4620714‑973‑900642/7 (SP)

DC042518 WESTERN DENTAL SERVICES2701 W 1st St, 92703‑3443714‑973‑202242/6

DC046471 LDJ FAMILY DENTISTRY1125 E 17th St Ste N257, 92701‑2215714‑558‑48951/0

DC048924 BRIGHT NOW! DENTAL ‑ SANTA ANA‑BRISTOL & ALTON3358 S Bristol St, 92704‑8202714‑361‑214116/0

DC058041 Saint Paul Dental1424 N Broadway, 92706‑3905714‑550‑60881/0 (AR SP)

DC060863 Tri Do DDS Dental Corp3801 S Harbor Blvd Ste D, 92704714‑444‑27441/0 (SP VI)

DC061644 Dentistry by Andy Tran2739 W Edinger Ave, 92704‑3523714‑957‑03081/0 (SP VI)

DC062110 Smileday Dental601 W 17th St, 92706714‑852‑31172/0 (SP)

DC062879 Mi Pueblo Dental Group516 W 17th St Ste A, 92706‑3677714‑972‑25061/0 (SP)

DC062958 Geva Dental1126 N Flower St Ste A, 92703‑2385657‑247‑05701/0 (SP)

66

DeltaCare® USA

DC160501 BAY DENTAL3620 S Bristol St Ste 307, 92704‑7316714‑540‑28361/0 (SP VI)

Santa BarbaraDC046450 CECILIA ORDONEZ DDS FAMILY DENISTRY1412 San Andres St Ste D, 93101‑4219805‑962‑74711/0 (SP)

DC046658 JEFFREY A STRATFORD‑JONES DDS5370 Hollister Ave Ste E, 93111‑2359805‑967‑03441/0 (SP)

DC047395 LYNDON LAMBETH DDS APDC504 W Pueblo St Ste 204, 93105‑6211805‑687‑26561/0

DC063391 Ericson Dental Group1919 State St Ste 102, 93101‑0406805‑884‑18742/0 (SP)

DC0C6701 SEA BREEZE DENTAL DR ZAK5168 Hollister Ave, 93111‑2526805‑683‑53001/2 (RU SP)

Santa ClaritaDC008536 LYONS DENTAL CARE24036 Lyons Ave, 91321‑2446661‑255‑10151/0 (SP)

DC008605 CANYON COUNTRY DENTAL GROUP26877 Sierra Hwy, 91321‑2274661‑251‑20024/0

DC022749 BRIGHT NOW DENTAL26477 Golden Valley Rd, 91350‑2973661‑253‑101012/2 (CH SP)

DC034141 GOLDEN TRIANGLE DENTAL22770 W Soledad Canyon Rd, 91350‑2629661‑259‑55402/0 (AR HI SP)

DC043064 COMFORT DENTAL27916 Seco Canyon Rd Ste 201, 91350‑3853661‑513‑06551/0 (AM KO SP)

DC046718 WESTERN DENTAL SERVICES INC23130 Lyons Ave, 91321‑2631661‑260‑320045/0 (SP)

DC057778 Stoney Creek Dental23238 Lyons Ave, 91321‑2633661‑255‑34591/0 (AR AM RO RU SP)

DC060406 Raymond Lotuaco DDS Inc26324 Bouquet Canyon Rd, 91350‑2308661‑481‑30781/0 (SP TA)

Santa Fe SpgsDC002239 SANTA FE DENTAL10009 Orr And Day Rd, 90670‑3506562‑484‑08081/0 (SP)

Santa MariaDC013162 FRIENDLY SMILES DENTAL GROUP1670 S Broadway, 93454‑7602805‑928‑67762/0 (AM SP)

DC039647 WESTERN DENTAL SERVICES2205 S Broadway, 93454‑7813805‑346‑213021/0 (SP)

DC046454 PACIFIC COAST SMILES426 Barcellus Ave Ste 101, 93454‑6926805‑925‑87671/0 (SP)

DC046652 MATTHEW LANE DDS2506 Professional Pkwy, 93455‑1602805‑938‑01001/0

DC046653 ZEN DENTAL GROUP2050 S Broadway Ste E, 93454‑8801805‑925‑37172/0 (CA CH 12 SP VI)

DC054061 Prasan Mohansinh Parmar DDS Inc1414 S Miller St Ste 7, 93454‑6916805‑922‑58841/0 (HI SP)

Santa MonicaDC011705 AMERICAN FAMILY DENTAL OFFICE900 Wilshire Blvd Ste 440, 90401‑1879310‑576‑13411/0 (SP)

DC012072 WILLSHIRE DENTAL3201 Wilshire Blvd Ste 110, 90403‑2335310‑829‑51810/2 (FR SP TH)

DC048636 COLUMBIA DENTAL GROUP1807 Wilshire Blvd Ste A, 90403‑5678310‑453‑54361/0 (CH 12 SP TA)

DC063245 Brightleaf Dental1304 15th St Ste 209, 90404‑1811310‑395‑18101/0 (AR SP)

DC0C9801 SANTA MONICA DENTAL1244 7th St Ste 101, 90401‑1648310‑393‑07431/0 (SP)

SanteeDC006421 TOWNE CENTER DENTAL GROUP9862 Mission Gorge Rd Ste E, 92071‑3873619‑596‑16007/2 (SP)

DC023560 SANTEE TOWN CENTER DENTAL GROUP246 Town Center Pkwy, 92071‑5803619‑312‑60064/3 (SP)

DC054230 Santee Smiles Dentistry Dental Group9331 Mission Gorge Rd Ste 105, 92071619‑448‑21586/0 (SP)

DC219501 EDWARD REIDY DDS9280 Mast Blvd, 92071‑2150619‑449‑85301/0 (RU)

Seal BeachDC048166 ROSSMOOR DENTAL GROUP12419 Seal Beach Blvd, 90740‑2710562‑431‑03939/0

DC058665 Philip P Nguyen DDS Inc1900 Saint Andrews Dr Ste A, 90740‑5553562‑430‑10541/0 (SP)

Sherman OaksDC007604 KW CHENG & V THAY INC13732 Ventura Blvd, 91423‑3024818‑907‑95331/1 (SP)

DC018911 ANAIT ALABYAN DDS4910 Van Nuys Blvd Ste 200, 91403‑1727818‑788‑21211/0 (AM RU SP)

DC047311 COMFORT CARE DENTAL5151 Hazeltine Ave, 91423‑1116818‑788‑20232/0 (AM SP)

DC060308 LA DENTAL EXPERTS4521 Sherman Oaks Ave Ste 201, 91403‑3807818‑668‑50081/0 (SP)

DC062074 Dent All by Dr. Z15301 Ventura Blvd Ste U5, 91403‑6647818‑788‑77111/0 (AR SP)

Simi ValleyDC006362 SIMI VALLEY DENTAL GROUP2410 Sycamore Dr Ste A, 93065‑2358805‑522‑26007/0 (SP)

DC012685 FIRST STREET DENTAL GROUP1197 E Los Angeles Ave Ste E, 93065‑2868805‑583‑57005/2 (SP)

DC029185 SIMI VALLEY SMILES2650 Tapo Canyon Rd Ste 107, 93063‑2308805‑522‑55162/1 (SP)

DC040224 BRIGHT NOW! DENTAL‑SIMI VALLEY2490 Sycamore Dr Ste A, 93065‑2302805‑426‑616318/1

DC057730 Western Dental Center1397 E Los Angeles Ave Ste F, 93065‑2866805‑577‑910037/0 (SP)

DC058846 PRODEN DENTAL3605 Alamo St Ste 310, 93063‑2186805‑526‑33311/0 (AM SP)

DC058865 Aura Dental3090 Cochran St Ste E, 93065‑2795805‑955‑01811/0 (AR AM)

DC058951 FAMILY DENTAL CARE495 E Los Angeles Ave, 93065‑7706805‑584‑22281/0 (SP)

67

DeltaCare® USA

DC176101 DENTAL CARE OF SIMI VALLEY1687 Erringer Rd Ste 201, 93065‑6509805‑527‑35341/0 (AM PE SP)

SolvangDC049045 JOHNSON FAMILY DENTAL GROUP678 Alamo Pintado Rd, 93463‑2200805‑688‑999914/0 (CH SP)

South El MonteDC043573 ANTHHONY S PAN9328 Garvey Ave Ste A, 91733‑4602626‑350‑05880/1 (CA CH 12 SP VI)

South GateDC012712 DR NAZIRI DENTAL CLINIC INC4186 Tweedy Blvd, 90280‑6159323‑569‑71311/0 (AR FR HE SP)

DC016011 CASTLE DENTAL CENTER9918 Atlantic Ave, 90280‑6449323‑567‑12279/1 (AR AM CA KO 12 RU SP)

DC059976 Western Dental Services Inc4444 Tweedy Blvd, 90280‑6304323‑564‑244452/0 (SP)

DC060669 All Kids Dental Care3173 Tweedy Blvd, 90280‑5739323‑564‑45541/0

DC061949 South Gate Family Dentistry2639 Santa Ana St, 90280‑2025323‑583‑14812/0 (SP)

South PasadenaDC011027 HEALTHY SMILE FAMILY DENTISTRY1315 Fair Oaks Ave Ste 103, 91030‑3868626‑799‑80680/1 (CA CH 12 SP)

DC047783 NEW VISION DENTAL1506 Huntington Dr, 91030‑4520626‑799‑28881/0 (SP VI)

DC057542 Dentists of South Pasadena Dental Group813 Fair Oaks Ave, 91030‑2605626‑593‑005311/0

StantonDC012597 BRIGHT NOW! DENTAL ‑ STANTON11001 Beach Blvd, 90680‑3216714‑891‑662314/0 (SP)

Studio CityDC005484 S C DENTAL CARE4366 Tujunga Ave, 91604‑2751818‑985‑54621/0 (PT RU SP TA)

DC016138 ROYAL DENTAL SPA11711 Moorpark St, 91604‑2112818‑505‑12110/1 (AM RU SP)

DC063832 Dentists of Studio City Dental Group12050 Ventura Blvd Ste C101, 91604‑2639818‑296‑91422/0 (SP)

Sun CityDC029914 SUN CITY DENTISTRY28125 Bradley Rd Ste 210, 92586‑2248951‑679‑05201/0 (SP)

Sun ValleyDC063349 Bright Now! Dental‑Sun Valley8345 Laurel Canyon Blvd, 91352‑3809818‑351‑35827/0 (SP)

SunlandDC134101 SUNLAND DENTAL CARE7902 Foothill Blvd, 91040‑2937818‑353‑55201/0 (AM FR SP)

SylmarDC022488 SAINT MINA FAMILY DENTAL12601 San Fernando Rd Ste H, 91342‑7733818‑364‑19911/0 (AR FR SP)

DC025912 KINGS FAMILY DENTAL GROUP14114 Polk St, 91342818‑364‑94441/0 (SP)

DC034824 AMERICAN SMILE DENTAL CARE13203 Gladstone Ave Ste A, 91342‑3116818‑833‑04442/0 (PE SP)

DC055535 Triple Dental13060 Glenoaks Blvd Ste 105, 91342‑3963818‑899‑18001/0 (AR AM SP)

DC059511 SMILES DENTAL GROUP12737 Glenoaks Blvd Ste 6, 91342‑4757818‑369‑58811/0 (AM RU SP)

TarzanaDC014329 THEODORE STOMEL DMD19525 Ventura Blvd, 91356‑2906818‑708‑71010/2 (RU)

DC041283 TARZANA DENTAL SPECIALIST18663 Ventura Blvd Ste 200, 91356‑4197818‑881‑90000/1 (KO SP)

DC050778 VICTORY COSMETIC DENTISTRY19231 Victory Blvd Ste 451, 91335‑6360818‑345‑33551/0 (SP)

DC053766 Tarzana Cosmetic Dentistry19458 Ventura Blvd Ste 10, 91356‑3037818‑304‑80211/0 (AM SP)

DC356401 FARA SALEHI DDS18740 Ventura Blvd Ste 105, 91356‑6302818‑344‑33571/0

TemeculaDC003887 SMILECARE‑TEMECULA32909 Temecula Pkwy Ste 102, 92592‑6907951‑972‑80804/1 (SP)

DC004223 THE OASIS FAMILY DENTAL41278 Margarita Rd Ste 101, 92591‑5579951‑695‑22901/1 (SP)

DC006422 PACIFIC DENTAL GROUP31754 Temecula Pkwy, 92592‑6814951‑694‑525510/0 (SP)

DC014356 BRIGHT NOW! DENTAL30571 Temecula Pkwy Ste D, 92592‑4821951‑693‑207912/5 (SP)

DC017606 MEADOWS DENTAL GROUP31843 Rancho California Rd Ste 300, 92592951‑676‑26137/1 (SP)

DC023259 BRIGHT NOW! DENTAL39804 Winchester Rd Ste B, 92591‑8320951‑695‑710011/3

DC024592 BUTTERFIELD DENTAL33321 Temecula Pkwy Ste 104, 92592‑4847951‑302‑75081/1 (CH SP TH)

DC025685 CREEKSIDE DENTAL41785 Nicole Ln Ste A3, 92591‑3874951‑699‑32501/0 (SP)

DC036408 FRIENDLY DENTAL CENTER28314 Old Town Front St, 92590‑1814951‑676‑89201/0 (SP)

DC037119 PROMENADE DENTAL CARE26550 Ynez Rd Ste B, 92591‑4625951‑296‑30111/0 (SP VI)

DC055471 Pore Dental Group INC31205 Pauba Rd Ste 205, 92592‑6220951‑506‑68722/0 (HI)

DC056687 Smiles of Temecula Dental Group27365 Jefferson Ave Ste L M, 92590‑5607951‑719‑11991/0 (SP)

DC057043 Contreras Dental Corporation32140 Temecula Pkwy Ste 203, 92592‑3896951‑302‑48881/0 (SP)

DC057727 Western Dental Center41115 Winchester Rd Ste 102, 92591‑6001951‑331‑702053/0 (SP)

DC059019 Dr Diana O Valdez31515 Rancho Pueblo Rd Ste 204, 92592‑4837951‑302‑33221/0

DC060522 Dr Zak Temecula Dental Group41593 Winchester Rd Ste 211, 92590‑4857951‑296‑33669/0 (RU SP)

DC062790 Temecula Modern Dentistry40705 Winchester Rd Ste A103, 92591951‑252‑60011/0 (SP)

68

DeltaCare® USA

DC063084 Anthem Dental32065 Temecula Pkwy Ste C, 92592‑6806951‑302‑93001/0 (AR SP)

DC063144 Anthem Dental29049 Overland Dr Ste C, 92591‑3637951‑506‑49001/0 (AR KO SP)

DC3C7101 TEMECULA DENTAL PRACTICE29560 Rancho California Rd Ste 100, 92591‑5294951‑699‑21447/2 (SP)

Temple CityDC022355 FRIENDLY DENTAL CARE10455 Lower Azusa Rd, 91780‑3470626‑444‑37441/0 (AM FR RU SP)

Thousand OaksDC006363 THOUSAND OAKS DENTAL GROUP1760 E Avenida De Los Arboles Ste A, 91362‑1392805‑493‑52008/1 (SP)

DC013064 ROYAL DENTAL SPA1459 E Thousand Oaks Blvd Ste A, 91362‑2806805‑494‑18311/0 (AM FR RU SP)

DC013796 EAST OAKS DENTAL GROUP593 N Moorpark Rd Ste B, 91360‑3732805‑494‑52554/2 (SP)

DC015562 DAR RADFAR DDS361 E Thousand Oaks Blvd, 91360‑5805805‑497‑94081/0 (SP)

DC059925 Aesthetic Dental Group1655 E Thousand Oaks Blvd Ste 204, 91362‑2838805‑449‑25521/0 (FR SP)

DC063392 1000 Smiles1000 Newbury Rd Ste 138, 91320‑6438805‑454‑10001/0 (HE PE RU SP)

Toluca LakeDC037096 TOLUCA DENTAL CARE10751 Riverside Dr, 91602‑2324818‑760‑99120/1 (SP)

DC0C4401 ESTEBAN BONILLA DDS10745 Riverside Dr Ste B, 91602‑2371818‑980‑28871/0 (CH SP TA)

DC3C3001 TINA GHOTANIAN DDS10916 Riverside Dr, 91602‑2210818‑762‑99661/0 (SP)

TorranceDC012660 BLUE SKY DENTAL GROUP17311 Yukon Ave, 90504‑2316310‑324‑33330/1 (KO SP)

DC021679 BEAVERLY GRACE CATALAN DMD22759 Hawthorne Blvd, 90505‑3613310‑373‑95221/0 (SP TA)

DC034768 A BEAUTIFUL SMILE DENTAL CENTER1431 W Knox St Ste 800, 90501‑1358310‑320‑11801/0 (SP TA)

DC038322 E‑YONSEI DENTAL OFFICE24205 Hawthorne Blvd Ste B, 90505‑6576310‑375‑51011/0 (JA KO SP)

DC046285 PCH SMILES DENTISTRY AND ORTHODONTICS2740 Pacific Coast Hwy, 90505‑7002310‑534‑30024/0 (SP)

DC056728 Century Dental1270 Sartori Ave, 90501‑2717310‑320‑14711/0 (HI SP)

DC057414 DENTISTS OF SOUTH BAY DENTAL GROUP5023 Pacific Coast Hwy, 90505‑5441310‑752‑49985/0

DC058330 Henry S Lee DDS23000 Crenshaw Blvd Ste 102, 90505‑3059310‑534‑24691/0 (12 SP)

DC058756 All Care Dental19019 Hawthorne Blvd Ste 100B, 90503‑1533310‑371‑01131/0 (AR SP)

DC062541 All Kids Dental Care923 W Carson St, 90502‑2003310‑533‑130010/0 (AR AM CH KO SP)

DC063010 Ace Dental Group23000 Crenshaw Blvd Ste 207, 90505‑3052310‑926‑22342/0 (KO)

DC063451 North Point Dental4350 Redondo Beach Blvd, 90504‑1031310‑370‑29661/0

DC0C6101 PCH DENTAL3710 Pacific Coast Hwy Ste 101, 90505‑5914310‑534‑26331/0 (AR)

DC0C8701 TORRANCE DENTAL ARTS23326 Hawthorne Blvd Ste 190 Bldg 10, 90505‑3753310‑378‑82090/1 (SP TA)

DC2C4201 VILLAGE FAMILY DENTAL1235 Sepulveda Blvd, 90502‑2626310‑530‑96560/1 (KM GR SP VI)

DC356001 WEST COAST DENTAL1730 Sepulveda Blvd Ste 1, 90501‑6901310‑325‑88881/1 (SP)

TulareDC036310 WESTERN DENTAL SERVICES1111 E Tulare Ave, 93274‑4561559‑688‑331330/9 (SP)

TustinDC002827 A A FAMILY DENTAL GROUP18102 Irvine Blvd Ste 205, 92780‑3424714‑731‑56560/1 (AM CH FR HI PL SP)

DC004385 SOUTHLAND DENTAL ARTS740 El Camino Real Ste 200, 92780‑4369714‑838‑32302/0 (HI SP)

DC011530 AMIT SHAH DDS17601 17th St Ste 100, 92780‑1946714‑544‑75111/0 (SP)

DC011651 TUSTIN DENTAL CARE12575 Newport Ave Ste B, 92780‑2452714‑731‑61000/1 (AR SP)

DC014939 SIMONA KISS DDS18102 Irvine Blvd Ste 201, 92780‑3424714‑730‑96561/0 (FR HU RO SP TA)

DC015838 KAY KIM DENTAL13132 Newport Ave Ste 220, 92780‑3429714‑505‑20101/0 (KO SP)

DC037842 MASOUD ARAM DDS13771 Newport Ave Ste 11, 92780‑4692714‑838‑77771/0 (SP)

DC054261 DENTAL OFFICE OF LAMISE KASSEM DDS17482 Irvine Blvd Ste D, 92780‑3032714‑480‑07901/0 (AR SP)

DC054786 Dr Haz Dental13372 Newport Ave Ste F, 92780‑3426714‑665‑08981/0

DC055072 Tustin Smile Care13422 Newport Ave Ste E, 92780‑3746714‑665‑00052/0

DC059522 Wen Lin Liu DDS Inc14771 Plaza Dr Ste D, 92780‑2779714‑616‑44161/0 (12)

DC062068 Rafi Dental Group14591 Newport Ave Ste 108, 92780‑6026949‑771‑72341/0 (SP TA)

DC062204 Welcome Dentistry1096 Irvine Blvd, 92780‑3527714‑838‑28752/0 (KO VI)

DC1C6201 TUSTIN DENTAL OFFICE13721 Newport Ave Ste 1, 92780‑4601714‑368‑14003/3 (SP)

UplandDC000232 ERIC CHIANG DDS1273 W 7th St, 91786‑7069909‑920‑95431/0 (12 SP)

DC013797 CROSSROADS DENTAL GROUP1875 N Campus Ave Ste C, 91784‑8211909‑985‑23027/2

69

DeltaCare® USA

DC025179 GRIORYAN PROFESSIONAL DENTAL CORPORATION536 E Foothill Blvd, 91786909‑291‑86251/0 (AM RU SP TA)

DC040225 BRIGHT NOW! DENTAL ‑UPLAND280 S Mountain Ave, 91786‑7029909‑285‑316010/1 (SP)

DC042358 KATYUSKA PAREDES DDS615 N Benson Ave Ste F, 91786‑5076909‑949‑40701/0 (SP)

DC059945 Village Dental and Orthodontics1227 W Foothill Blvd, 91786‑3681909‑608‑07001/0 (SP)

DC199101 JOHNSON FAMILY DENTISTRY440 N Mountain Ave Ste 101, 91786‑5183909‑621‑60022/0 (SP)

ValenciaDC007663 VALENCIA DENTAL GROUP24218 Valencia Blvd, 91355‑5391661‑288‑02887/1 (SP)

DC015666 CANYON DENTAL GROUP28237 Newhall Ranch Rd, 91355‑0986661‑257‑42428/1 (HI SP)

DC016418 VALENCIA DENTAL GROUP28134 Newhall Ranch Rd, 91355‑0990661‑607‑02023/1 (SP)

DC030725 GEORGE KOUTSOUKOS DDS24155 Magic Mountain Pkwy, 91355‑3904661‑222‑77241/0 (AM GR RU SP)

DC042693 MAYO DENTAL25864 Tournament Rd Ste F, 91355‑2369661‑291‑65000/0 (SP)

DC062141 JR Dental23501 Cinema Dr Ste 112, 91355‑5429661‑290‑33551/0 (FR SP TA)

DC131101 ZAK DENTAL CARE23838 Valencia Blvd Ste 150, 91355‑5332661‑253‑400012/0 (KO SP)

Valley VillageDC013584 ALLEN ZEBRACK DDS12840 Riverside Dr Ste 406, 91607‑3351818‑763‑97011/0

DC035058 SHANRAM NOURI DENTAL CORP5216 Laurel Canyon Blvd, 91607‑2710818‑769‑13470/1 (SP)

DC305301 LAUREL CHANDLER DENTAL4717 Laurel Canyon Blvd Ste 200, 91607‑3990818‑508‑22500/1 (SP TA)

Van NuysDC002801 HAMLIN DENTAL GROUP14401 Hamlin St Ste D, 91401‑1410818‑782‑69191/1 (AR AM CA CH 12 PT SP TA)

DC004000 SMILECARE‑VALLEY15643 Sherman Way Ste 300, 91406‑4177818‑786‑22090/0

DC013875 WEST COAST DENTAL GROUP OF VAN NUYS13716 Sherman Way, 91405‑2626818‑988‑20209/1 (SP)

DC018879 LOURDES AQUINO DDS14435 Sherman Way Ste 107, 91405‑6227818‑785‑74981/0 (SP TA)

DC021782 GLOBAL DENTAL PRACTICE14434 Hamlin St Ste 2, 91401‑1461818‑781‑51801/0 (SP)

DC022741 MARCLAY BROMONT FAMILY DENTAL GROUP14435 Hamlin St Ste 104, 91401‑6205818‑781‑00040/1 (PE RU SP)

DC023866 SINAI DENTAL GROUP7335 Van Nuys Blvd Ste 101, 91405‑1951818‑780‑75551/0 (AM SP)

DC025119 MEHRZAD FIROUZBAKHT DDS14100 Victory Blvd, 91401‑1958818‑908‑91991/0 (SP)

DC030582 GOLDEN CARE DENTISTRY6330 Van Nuys Blvd B, 91401‑2610818‑785‑99440/1 (SP)

DC035480 MIRO ITSKOVICH DDS13251 Victory Blvd, 91401‑2025818‑308‑61131/0 (RO RU SP)

DC039022 ST GEORGE DENTAL6648 Van Nuys Blvd, 91405‑4617818‑781‑25001/0 (AR RU SP)

DC054161 Affordable Dental6251 Van Nuys Blvd, 91401‑2711818‑782‑50201/0 (SP)

DC059505 Western Dental Services Inc14600 Sherman Way Ste 100B, 91405‑5867818‑756‑695017/0

DC063846 Family Care Dental14515 1/2 Victory Blvd, 91411‑1619818‑809‑20011/0 (SP)

VenturaDC004109 WOODSIDE DENTAL CARE10883 Telegraph Rd, 93004‑1272805‑647‑13221/1

DC016444 MAIN STREET DENTAL GROUP4360 E Main St Ste C, 93003‑8279805‑644‑61103/0 (SP)

DC043599 WESTERN DENTAL SERVICES2750 E Main St, 93003‑2875805‑643‑355625/4 (SP)

DC045115 PLAZA DENTAL GROUP4744 Telephone Rd Ste 4, 93003‑5258805‑653‑06200/2 (SP)

DC057710 Ventura Dental Group1001 Partridge Dr Ste 210, 93003‑0716805‑644‑95011/0 (AR CA SP)

DC061979 R Malekzadeh DDS Inc5722 Telephone Rd Ste 4, 93003‑5319805‑804‑53831/0 (SP)

DC222901 ANA HERNANDEZ CARR DDS2100 Goodyear Ave Ste 11, 93003‑7749805‑985‑11591/0 (FR SP)

DC2C5201 AMERIDENT GROUP6555 Telephone Rd Ste 8, 93003‑4460805‑642‑27901/0 (SP)

VictorvilleDC019900 DESERT DENTAL GROUP12640 Hesperia Rd Ste A, 92395‑7753760‑241‑33368/0 (AR AM CH HI KO PE SP TA TH)

DC021052 DESERT SKY DENTAL GROUP15667 Roy Rogers Dr Ste 101, 92394‑2159760‑843‑58245/2 (SP)

DC026088 VICTOR VALLEY DENTAL GROUP14689 Valley Center Dr Ste 101, 92395‑4277760‑245‑01510/1 (SP)

DC029897 DR HATTAR DENTAL15366 Eleventh St Ste F, 92395‑3726760‑243‑35950/1 (AR SP)

DC306401 S M BHATT DDS14495 Seventh St Ste A, 92395‑4233760‑245‑78001/1 (AR SP)

DC390901 DESERT VALLEY DENTAL GROUP13792 Bear Valley Rd Ste 1, 92392‑8713760‑245‑20107/2 (SP)

VisaliaDC036329 WESTERN DENTAL SERVICES1230 S Mooney Blvd, 93277‑4436559‑624‑050333/10 (SP)

DC036331 WESTERN DENTAL SERVICES828 S Mooney Blvd, 93277‑2212559‑636‑600036/6 (SP)

DC054368 Packwood Creek Dental Group4129 S Mooney Blvd Ste B, 93277‑9147559‑732‑19536/0

70

DeltaCare® USA

DC055580 Visalia Modern Dentistry Dental Group3206 N Dinuba Blvd Ste F, 93291‑8730559‑334‑20136/0 (SP)

VistaDC045733 VISTA DENTAL CARE138 Civic Center Dr Ste 115, 92084‑6042760‑630‑50001/0 (HE SP)

DC050776 NORTH COUNTY DENTAL CARE1000 E Vista Way, 92084‑4602760‑940‑42662/0 (AM CH LO 12 RU SP TH)

DC059345 Gentle Dental Vista1680 S Melrose Dr Ste 108, 92081‑5472760‑536‑84703/0 (SP)

DC059615 Vista Dental Group435 S Melrose Dr Ste 105, 92081‑6661760‑758‑75803/0

DC062127 Western Dental Services Inc1450 N. Santa Fe Ave Suite A&C, 92083760‑240‑74939/0 (HI SP)

WalnutDC000652 WALNUT HILLS FAMILY DENTISTRY18758 Amar Rd, 91789‑4169626‑912‑55990/1 (AR FR SP)

DC014045 GARVEY DENTAL OFFICE368 N Lemon Ave Ste E, 91789‑2345626‑851‑00201/0 (SP TA)

DC039447 PEDRO GONZALEZ DDS INC20199 Valley Blvd Ste F, 91789‑2671909‑468‑00910/1 (SP)

DC364401 TEIN CHUN WANG DDS1309 N Grand Ave, 91789‑1317909‑594‑78991/0 (CA 12)

Walnut ParkDC027165 ALAMEDA DENTAL GROUP7700 S Alameda St Ste A, 90255‑3745323‑585‑92001/0 (SP)

West CovinaDC002401 EDISON DER DDS148 N Grand Ave, 91791‑1728626‑858‑33051/0

DC003510 NEWPORT DENTAL151 N Azusa Ave, 91791‑1342626‑331‑00765/0 (12 SP TA)

DC004074 GINA BARRAMEDA DMD1519 E Amar Rd, 91792‑1619626‑964‑67990/2 (TA TA)

DC011835 SMARTCARE DENTAL PRACTICE415 S Glendora Ave Ste A, 91790‑3048626‑918‑83381/0 (SP TA)

DC013596 BRIGHT NOW DENTAL1000 West Covina Pkwy Ste A, 91790626‑338‑48489/1

DC038242 SUNSET DENTAL PROFESSIONALS1042 W West Covina Pkwy, 91790‑2810626‑960‑27661/0 (CH SP)

DC055354 Rubin Nichols DDS Inc1031 E Amar Rd, 91792‑1340626‑330‑66553/0 (KO SP TA TA)

DC056557 West Covina Dental Group2700 E Workman Ave Ste A, 91791‑1628626‑634‑33934/0

DC056626 Dr Luis Javier Vigilarolo266 S Glendora Ave Ste A, 91790‑3042626‑653‑92760/0 (SP)

DC057215 Smile Center of West Covina820 W Merced Ave, 91790‑4901626‑918‑33881/0 (SP)

DC058740 American Dental Group of West Covina436 N Sunset Ave, 91790‑1652626‑337‑72713/0 (PE SP)

DC060235 APEX IMPLANT CENTER AND DENTISTRY360 S Glendora Ave Ste 1, 91790‑5939626‑671‑58001/0 (HI SP)

DC063243 Western Dental Services Inc1208 W Francisquito Ave, 91790626‑917‑09007/0

DC160201 WEST COVINA FAMILY DENTISTRY450 S Glendora Ave Ste 106, 91790‑3068626‑856‑33170/1 (AR SP VI)

DC221001 RAFIK YANNI DDS2413 S Azusa Ave, 91792‑1536626‑913‑14211/0 (AR SP) DC329601 QUEENS DENTAL GROUP910 S Sunset Ave Ste 3, 91790‑3409626‑337‑61663/0 (AR AM HI SP TA)

DC355001 SOUTHERN CALIFORNIA DENTAL SERVICE1014 S Glendora Ave, 91790‑4920626‑918‑28861/0 (CH SP)

West HillsDC013266 STEPHEN CHEUNG DDS23101 Sherman Pl Ste 417, 91307‑2017818‑348‑95951/0

DC015734 PLATT VILLAGE DENTAL GROUP6446 Platt Ave, 91307‑3216818‑716‑70019/1 (SP)

DC021392 FALLBROOK DENTAL GROUP6739 3/4 Fallbrook Ave, 91307‑3522818‑592‑60601/0 (SP TA)

DC060732 Birva B Joshi DDS Inc7301 Medical Center Dr Ste 305, 91307818‑887‑71721/0 (AM HI SP)

West HollywoodDC011841 OMID FARAHMAND DMD9201 W Sunset Blvd Ste 915, 90069‑3710310‑273‑36501/0

DC016502 VICTORIA OLSHANSKY DDS INC1136 N Fairfax Ave, 90046‑5307323‑650‑69361/0 (HE RU)

DC050079 SUNSET SMILE DENTAL CORP8606 W Sunset Blvd # A, 90069‑2302310‑424‑36902/0 (AR AM CH HE 12 RU SP TA)

West Los AngelesDC016570 AFSHIN GOLYAD DDS12340 Santa Monica Blvd Ste 241, 90025‑0405310‑820‑70100/1 (SP)

Westlake VillageDC011740 SONA GEORGIAN DDS32144 Agoura Rd Ste 213, 91361‑4054818‑991‑46641/0 (AM RU SP)

DC046272 LINDERO CANYON DENTAL GROUP5784 Lindero Canyon Rd Ste B, 91362‑4088818‑706‑01315/0 (CH SP)

DC057171 WELLNESS DENTAL CENTER3665 E Thousand Oaks Blvd, 91362‑3606805‑496‑33471/0 (RU SP)

DC060028 Dental Wellness of Westlake Village4685 Lakeview Canyon Rd, 91361‑4028818‑879‑74801/0 (HI SP)

WestminsterDC004491 NEWPORT DENTAL15458 Beach Blvd, 92683‑6210714‑898‑32207/2 (SP VI)

DC034668 ERIC W HWANG DDS INC14120 Beach Blvd Ste 112, 92683‑4454714‑894‑05741/0 (SP)

DC040518 TAYLOR PHAM DENTAL CORP15310 Goldenwest St, 92683‑6150714‑893‑24111/1 (SP VI)

DC042515 WESTERN DENTAL SERVICES8001 Westminster Blvd, 92683‑3302714‑889‑413138/11 (SP VI)

DC058764 Pavilion Dental16430 Beach Blvd, 92683‑7859714‑848‑81001/0 (AR FR SP)

71

DeltaCare® USA

DC063802 Lavang Dental Center9435 Edinger Ave, 92683‑7425714‑775‑18181/0 (FR VI)

WhittierDC000026 RODOLPHO BURQUEZ DDS11574 Hadley St, 90606‑1955562‑699‑38381/0 (SP)

DC044913 WHITTIER DENTAL16406 Whittier Blvd, 90603‑3043562‑694‑03961/0 (KO SP)

DC046712 WESTERN DENTAL SERVICES INC14880 Whittier Blvd, 90605‑1727562‑698‑655557/0 (SP TA)

DC056521 Village Dental Center6742 Greenleaf Ave Ste 300, 90601‑5154562‑945‑16842/0 (CA CH 12 SP)

DC059428 Saman Edalat DDS Inc13431 Telegraph Rd, 90605‑3435562‑946‑28385/0 (AR AM PE SP)

DC060275 Tigran Shahmanyan DDS INC12640 Whittier Blvd, 90602‑2926562‑698‑13141/0 (AM RU SP)

DC062003 Whittier Family Dental Care10420 Whittier Blvd, 90606‑1336562‑463‑33321/0 (SP)

DC283501 WHITTIER DENTAL CENTER14564 Whittier Blvd, 90605‑2129562‑693‑82021/0 (HE 13 KO PE RO SP TA)

DC396701 FRIENDLY HILLS FAMILY DENTISTRY14544 Whittier Blvd, 90605‑2129562‑698‑98551/0 (HI SP)

WildomarDC010723 DIANA DOYABUT & BRYAN WATANABE23905 Clinton Keith Rd Ste 108, 92595‑7898951‑304‑97008/1 (SP)

DC011291 BEAR CREEK DENTAL GROUP & ORTHO36068 Hidden Springs Rd Ste H, 92595‑7681951‑678‑07907/2 (FR SP)

WilmingtonDC012740 WILMINGTON DENTAL1610 N Avalon Blvd, 90744‑1431310‑835‑313115/0 (SP)

DC017527 DENTAL OFFICE445 E Anaheim St Ste M, 90744‑4600310‑835‑35350/1 (HE SP)

WinchesterDC1C5101 WINCHESTER DENTAL CENTER33040 Simpson Rd, 92596951‑926‑24891/0 (KO SP)

WinnetkaDC002853 EDWIN PAPAZIAN DDS INC7616 Winnetka Ave Ste 1, 91306‑2686818‑772‑62221/0 (AM SP)

Woodland HillsDC011398 AROUND THE CORNER DENTAL SPA22030 Clarendon St Ste 102, 91367‑6370818‑999‑44451/0 (SP)

DC013689 EDWARD ROSEN & ASSOCIATES21500 Ventura Blvd Ste 200, 91364‑1939818‑999‑61650/3 (AM CH SP TA TA VI)

DC030553 AFFINITY DENTAL GROUP5312 Comercio Ln Ste B, 91364‑2026818‑884‑43380/0 (SP)

DC040681 NEW AGE FAMILY DENTAL GROUP23111 Ventura Blvd Ste 204, 91364‑1160818‑225‑16300/1 (SP)

Yorba LindaDC011539 YORBA LINDA DENTAL GROUP18432 Yorba Linda Blvd Ste D, 92886‑4008714‑970‑28016/2

DC017522 RICHARD HAMATY DMD18509 Yorba Linda Blvd, 92886‑4135714‑779‑13130/1

DC022020 YORBA LINDA DENTAL ARTS19831 Yorba Linda Blvd Ste A, 92886‑2851714‑406‑05560/2

DC038104 YORBA LINDA SMILES DENTISTRY ORTHO DENTAL GROUP16691 Yorba Linda Blvd, 92886‑2046714‑854‑99202/1 (SP)

DC057194 Blessed Smile Dentistry of Yorba Linda4846 Valley View Ave Ste B, 92886‑3600714‑579‑88881/0

DC062033 Joseph Rajabi DDS Inc17540 Yorba Linda Blvd, 92886‑3825714‑986‑92931/0 (SP)

YucaipaDC000925 IMPERIAL DENTAL PRACTICE34880 Yucaipa Blvd, 92399‑4235909‑797‑113611/0 (SP)

WellsDC039545 WOO ALBERT LEE DDS74900 Highway 111 Ste 110, 92210760‑836‑00521/0 (KO)

Southern California offices (closed)AlhambraDC059369 Biyan Yang DDS Inc1234 S Garfield Ave Ste 101, 91801‑5068626‑576‑81002/0 (CH SP VI)

AnaheimDC057365 Tarun Patel APDC853 N Harbor Blvd, 92805‑1810714‑535‑24871/0

ArcadiaDC017483 DRS CHENG & KIM1043 W Huntington Dr, 91007‑6536626‑445‑96601/1 (CH KO 12 SP)

DC026090 LIVE OAK DENTAL288 E Live Oak Ave Ste C, 91006‑5640626‑898‑00080/1 (SP TA TA)

BakersfieldDC018808 JAVIER CENTRAL VALLEY DENTAL1415 Brundage Ln, 93304‑3114661‑323‑00761/0 (SP TA)

BellflowerDC354901 BENJAMIN WOO DDS17802 Clark Ave, 90706‑6505562‑925‑83381/0 (CA CH 12 SP TA TA)

Beverly HillsDC052428 Victoria Cohen‑Gadol DDS Inc435 N Bedford Dr Ste 306, 90210‑4344310‑276‑64001/0 (SP)

BreaDC025702 BREA DENTAL ARTS710 N Brea Blvd Ste E, 92821‑3352714‑529‑85583/0 (CA CH 12 SP)

Canoga ParkDC022417 ALLURE DENTAL8358 Topanga Canyon Blvd, 91304‑2344818‑348‑84001/0 (AM SP)

DC059873 ZAHRA AMIRANI DDS A PROFESSIONAL CORPORATION22030 Sherman Way Ste 204, 91303‑1875818‑370‑78481/0 (FR SP TA)

CarsonDC012343 JAUBIN NGUYEN DDS1754 E Carson St, 90745‑2506310‑518‑70681/0 (SP VI)

DC013256 LETICIA TOLENTINO DMD INC860 E Carson St Ste 106, 90745‑7940310‑522‑97692/1 (13 SP TA TA)

ChinoDC016554 BRIGHT SMILE DENTAL CARE12345 Mountain Ave Ste O, 91710‑2783909‑364‑13301/0 (HI SP)

DC022108 BRANDON CHIU DDS13768 Roswell Ave Ste 211, 91710‑1407909‑590‑82551/1 (12)

Chino HillsDC004765 CHINO HILLS DENTAL OFFICE2983 Chino Ave Ste A5, 91709‑3576909‑628‑70001/0 (KO SP)

72

DeltaCare® USA

Chula VistaDC006103 MARIA LUISA VALES DMD88 E Bonita Rd Ste F, 91910‑3057619‑427‑26461/0 (TA)

City Of IndustryDC058840 Beautiful Dentistry17827 Colima Rd, 91748‑1729626‑965‑78885/0 (CH KO SP)

Culver CityDC381601 STEVEN SELDON DDS10310 Culver Blvd, 90232‑3405310‑204‑07001/0 (SP)

CypressDC012688 SAMUEL AU DDS5305 Lincoln Ave, 90630‑2235714‑826‑99881/0 (CA 12 SP)

DowneyDC359801 CHARLES STUCKEN DDS8847 Imperial Hwy, 90242‑3958562‑861‑40111/0 (SP)

El CajonDC024248 SUN VALLEY DENTAL CARE1209 E Main St, 92021‑7245619‑442‑07071/0 (SP)

FontanaDC016892 SIERRA FAMILY DENTISTRY9870 Sierra Ave Ste B, 92335‑1713909‑823‑20200/1 (HI SP)

Fountain ValleyDC063015 Dr Chris Smiles18120 Brookhurst St Ste 13, 92708‑6727714‑962‑13001/0 (SP VI)

FullertonDC013788 JANE SKUBEN DDS1690 N Placentia Ave Ste A, 92831‑5527714‑528‑06000/1 (SP)

Garden GroveDC052430 SMILEDAY DENTAL12872 Harbor Blvd, 92840‑5807714‑638‑82731/0 (SP VI)

DC059770 AllStar Dental13872 Harbor Blvd Ste 1A‑3, 92843‑4041714‑265‑10001/0 (AR PT SP)

GlendaleDC058172 Mark M De Leon DDS1201 N Pacific Ave Ste 101, 91202818‑240‑91421/0 (SP)

GlendoraDC023401 SAN DIMAS DENTAL GROUP2220 E Route 66 Ste 107, 91740‑7600626‑857‑47021/1 (RU)

DC054482 Minal Patel DDS Inc641 W Route 66 Ste D, 91740‑4153626‑914‑30681/0

Hacienda HtsDC030838 KATY CHOU FAMILY DENTISTRY17138 Colima Rd Ste C, 91745‑6783626‑854‑18260/1 (CA CH 12 SP)

Hawaiian GardensDC063321 California Dentistry & Braces12309 Carson St, 90716‑1603562‑403‑88181/0 (CH KO)

HawthorneDC007529 HAWTHORNE FAMILY AND COSMETIC DENTAL13901 Hawthorne Blvd, 90250‑7001310‑675‑50501/0 (SP)

DC286801 BURTON SCHNIEROW DDS13450 Hawthorne Blvd, 90250‑5806310‑679‑01061/0 (AR CH HI IT SP TA TA VI)

HemetDC004077 HEMET DENTAL CLINIC940 E Morton Pl, 92543‑4529951‑652‑27961/0 (SP)

Huntington BeachDC151801 GABRIEL CAPDEVILA DDS6082 Edinger Ave Ste A, 92647‑3264714‑846‑28951/0 (SP)

Huntington ParkDC012919 BINAFARD DENTALAND CORPORATION7136 Pacific Blvd Ste 210, 90255‑7620323‑585‑10003/1 (AR AM CH KO 12 RU SP TA)

InglewoodDC008571 CENTURY DENTAL DR CAMPBELL257 S Market St, 90301‑2305310‑677‑47670/1 (KO SP)

DC038127 COMPREHENSIVE DENTAL141 N Prairie Ave, 90301‑1904310‑330‑00801/0 (SP)

DC375501 RAYMONT JOHNSON JR DDS808 E Manchester Blvd, 90301‑1914310‑671‑12341/0 (SP)

IrvineDC035120 O C SMILE DENTAL17931 Macarthur Blvd, 92614‑6505949‑862‑00280/1 (AR SP)

DC044154 ASHORE DENTAL4980 Barranca Pkwy Ste 204, 92604‑8653949‑552‑85470/1 (CA CH 12 SP)

DC059708 OC Dental Specialists15825 Laguna Canyon Rd Ste 206, 92618‑2127949‑789‑89892/0 (AR FR HE HI RU SP)

La HabraDC1C2401 HARBOR DENTAL971 N Harbor Blvd, 90631‑3103562‑690‑35510/1 (CH SP)

DC355701 JULIET CHUA DDS2241 W Whittier Blvd, 90631‑3465562‑691‑74381/0

La MesaDC037728 JAVADI SMILES5308 Lake Murray Blvd Ste C, 91942‑1334619‑464‑44111/0 (SP)

DC358801 SMILEHAVEN DENTAL CENTER4700 Spring St Ste 210, 91942‑0273619‑464‑28010/1 (CA SP TA TA)

La PalmaDC347501 REGINA TAN DDS INC30 Centerpointe Dr Ste 10, 90623‑2575714‑994‑08881/0 (TA)

LancasterDC041018 AMERICAN BRIGHT DENTAL44810 Elm Ave, 93534‑3106661‑945‑26451/0 (SP TA)

Long BeachDC017218 DR. CAMPBELL CENTURY DENTAL2211 E 7th St, 90804‑4515562‑439‑65620/0

DC019606 BIXBY KNOLLS DENTAL GROUP3903 Long Beach Blvd, 90807‑2614562‑427‑24782/0 (SP) DC056960 Knolls Dental Care3932 Long Beach Blvd Ste A, 90807‑2615562‑427‑38901/0 (KO SP)

Los AlamitosDC025687 ENHANCE DENTAL4300 Katella Ave, 90720‑3563562‑799‑83001/0 (KO SP)

Los AngelesDC000637 DAN BENYAMINI DDS1826 W 7th St, 90057‑4102213‑484‑66602/0 (SP VI)

DC018593 LADERA DENTAL GROUP5814 Obama Blvd, 90016‑4406310‑836‑72001/0 (HI SP)

DC018954 CHINATOWN SERVICE CENTER767 N Hill St Ste 213, 90012‑2365213‑808‑17901/0 (CA 12 RU SP)

DC062177 Seon Rohs Dental Office5520 Santa Monica Blvd Ste 104, 90038‑4089323‑962‑28281/0 (KO SP)

DC382501 MICHEL H ELYSON DDS4975 Whittier Blvd, 90022‑3131323‑263‑21251/0 (SP)

Mission ViejoDC061287 Parkview Dental Group MV26800 Crown Valley Pkwy Ste 405, 92691‑8022949‑347‑08073/0 (FR GE IT KO RO SP TA VI)

73

DeltaCare® USA

MontebelloDC035763 DENTAL CARE OF MONTEBELLO1332 W Whittier Blvd, 90640‑4601323‑888‑09991/1 (AR SP)

National CityDC063459 San Ysidro Health South Bay330 E 8th St 340, 91950‑2312619‑662‑41001/0 (SP TA)

NorthridgeDC029567 AT EASE DENTISTRY11155 Tampa Ave, 91326‑2254818‑363‑33821/0 (RU SP)

NorwalkDC013590 NORWALK DENTAL ASSOC INC13828 Pioneer Blvd, 90650‑3918562‑863‑72531/0 (SP VI)

DC029294 ROSE DENTAL IMPLANT CENTER13041 Rosecrans Ave Ste 207, 90650‑0505562‑404‑16140/1 (KO SP)

OntarioDC060154 M Zaida Carbajal Dental Practice611 N Euclid Ave, 91762‑3223909‑235‑41481/0 (SP)

OrangeDC056816 Pearl Dental1714 N Tustin St, 92865‑4603714‑998‑55021/0 (HI SP)

DC058759 Genuine Family Dentistry1122 E Lincoln Ave Ste 115, 92865714‑282‑91311/0 (AR SP)

Rch CucamongaDC026932 RENAISSANCE DENTAL CARE9080 Milliken Ave Ste 100, 91730‑5559909‑987‑00400/1

RedlandsDC012341 REDLANDS DENTAL ASSOCIATES1895 Orange Tree Ln Ste 101, 92374‑0112909‑793‑52700/1 (AR AM RU SP)

ResedaDC002754 JOHN FOROUTAN DDS18308 Sherman Way Ste 1, 91335‑4475818‑881‑04041/0 (SP)

RialtoDC000011 TRI STAR FAMILY DENTAL CENTER106 N Eucalyptus Ave, 92376‑6102909‑875‑12991/0 (SP VI)

RiversideDC047287 LA SIERRA FAMILY DENTISTRY3410 La Sierra Ave Ste D, 92503‑5205951‑354‑95501/0 (LO SP TH)

Rowland HeightsDC012594 STEVEN CHIU DDS INC18906 Gale Ave Ste B, 91748‑1388626‑965‑56181/0 (12)

DC058020 Bo Feng DDS Inc18736 Colima Rd, 91748‑2916626‑839‑83891/0 (12)

San BernardinoDC029297 DR GILLS FAMILY DENTISTRY1584 W Base Line St Ste 103, 92411‑1746909‑885‑31002/0 (AR AM FR KO PE SP)

San DiegoDC031633 BOULEVARD DENTAL CENTER3531 El Cajon Blvd Ste A, 92104‑1512619‑584‑89751/0 (VI)

DC051593 MISSION FAMILY DENTAL5995 Mission Gorge Rd Ste A, 92120‑4028619‑280‑65001/0

DC051595 CARMEL MOUNTAIN DENTISTRY10175 Rancho Carmel Dr Ste 126, 92128858‑675‑90551/0 (PT SP TA VI)

DC060708 Pirouz Salehi DDS Inc7695 Cardinal Ct Ste 300, 92123‑3357858‑277‑93001/0 (SP)

San DimasDC029952 SIERRA DENTAL CARE1301 W Arrow Hwy Ste 120, 91773‑2330909‑592‑83381/0 (TA TA)

DC3C6601 BOUZ DENTAL CORPORATION639 E Foothill Blvd Ste A, 91773‑1253909‑599‑20291/0 (AR RU)

San GabrielDC0C3501 THOMAS WU DDS1103 S San Gabriel Blvd Ste A, 91776‑3152626‑286‑70001/0 (CA CH 12 SP)

Santa AnaDC012876 PINNACLE DENTAL GROUP31 E Macarthur Cres Ste 109, 92707‑5907714‑549‑12481/0 (SP)

Santa BarbaraDC046651 MONTECITO DENTAL GROUP1165 Coast Village Rd Ste I, 93108‑3769805‑565‑98371/0

DC046913 JOHNSON FAMILY DENTAL3906 State St, 93105‑3114805‑687‑676713/0 (CH SP)

Sherman OaksDC391701 GUS HUERTA DDS4910 Van Nuys Blvd Ste 204, 91403‑1761818‑995‑84841/0 (RO SP)

South GateDC013535 PERRIS FAMILY DENTAL CARE10530 Atlantic Ave, 90280‑7024323‑569‑50001/0 (SP)

South PasadenaDC031178 SINAI DENTAL PRACTICE820 Mission St Ste A, 91030‑3385626‑405‑90901/0 (SP TA)

TorranceDC016541 JIN YANG DDS1001 W Carson St Ste G, 90502‑2051424‑558‑37721/0 (SP)

DC058826 MB DENTAL18506 Hawthorne Blvd, 90504‑4515310‑483‑77791/0 (SP)

TustinDC055143 So Cal Smiles Dentistry12791 Newport Ave Ste 200, 92780‑8023714‑730‑77771/0 (CA CH HI KO 12 SP TA)

VictorvilleDC032502 PROCARE DENTAL12602 Amargosa Rd Ste D, 92392‑7640760‑951‑99970/2 (SP TA TA)

West CovinaDC383201 GREGORY ROBINS FMLY DNSTRY1129 S Glendora Ave, 91790‑4955626‑919‑77070/2 (CA CH SP)

West HillsDC021479 VALLEY CIRCLE FAMILY DENTAL23727 Roscoe Blvd, 91304‑3041818‑888‑88240/1 (SP)

Westlake VillageDC061780 Kevin Jan Dentistry176 Auburn Ct Ste 3, 91362‑3679805‑370‑63901/0 (CH)

WestminsterDC046905 DR SAM C MORCOS7271 Westminster Blvd, 92683‑4235714‑894‑33061/0 (AR FR SP VI)

DC054694 Le Kha D. DMD9900 McFadden Ave Ste 101, 92683‑6978714‑531‑57702/0 (FR SP VI)

DC115401 THANH NGOC NGUYEN DMD INC15355 Brookhurst St Ste 101, 92683‑7071714‑531‑25903/0 (FR SP VI)

Yorba LindaDC050615 MINT DENTAL OC16963 Imperial Hwy, 92886714‑577‑09801/0

Visit us at our website: deltadentalins.com.

Additional Dental Offices will be added as required. You may call DeltaCare USA Customer Care at 800‑422‑4234 for updates to

the provider list. If any office is closed to further enrollment, Delta Dental reserves the right to assign you another dental office as close to your home

as possible.

74

Administered by

17871 Park Plaza Drive, Suite 200 Cerritos, CA 90703

KPIC’s dental program information 800‑933‑9312

DeltaCare USA information 800‑422‑4234

Delta Dental is a registered mark of Delta Dental Plans Association.

SA‑01‑904‑05 KA5 PB#123503 (rev. 09/19)

two great dental programs - kaiser permanente · 2019-10-03 · dentist (ppo dentist). if you...

Documents