Your dental plan is just a click away!

Download the form by clicking here and send it to us.

• If you are paying by credit card fax the completed form to (301) 424-4013.
  
  
• If you are paying with check mail the completed form to:

  Insurance Brokers of America
  600 Jefferson Plaza, Suite M6
  Rockville, MD 20852

If you have any questions call us at (301) 424-4011.