Email Customer Service Inquiry Type Customer Type: Member Provider Individual & Family Product Prospective Customer Broker Plan Administrator Other Provider Name: * TIN: * Type Of Inquiry: * ClaimIndividual PlanGroup AdministrationProvider DirectoryeOfficeOtherID CardeInvoiceRegistrationBenefits *Check All That Apply Contact Information Contact Name: * Phone: Email: * Contact Preference: PhoneEmail Account Information SUBSCRIBER: PATIENT: *Same As Subscriber First Name: * First Name: Last Name: * Last Name: Birthday: * Birthday: Member ID: * Company: * Note: Member ID is the last four digits of your SSN or your Alt ID if one was assigned – See your dental ID card. State of Residence: * --STATE-- Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please provide a short description below of how we can help you:* Main Phone: Local 803-731-2495 Toll-Free 800-529-3268 Customer Service: Toll Free 800-335-8266 service@deltadentalmo.com Mailing Address: PO Box 8690 St. Louis, MO 63126-0690