Please mail completed application form to:
Mainline Dental Plan, Inc.
9 Furler Street
Totowa, NJ 07512
Phone: 1- 877- 880- PLAN (7526)
11am – 8pm EST
Fax: (702) 880-7531
| Single Membership:
- Single coverage is for the member only.
Member & Spouse
- Includes member and spouse or domestic partner residing in the same household.
- Parent/Child coverage includes member and 1 child under the age of 18 residing in the same household.
- Family coverage includes member, spouse or domestic partner, and all children under the age of 18 residing in the same household.
- Group coverage can be provided for employers with 4 or more employees.
Please call our office for a quote.