Provider Registration

Licensing Information To ensure security and data confidentiality, you must register to use Benefits Lookup. It's a quick authentication process. Fill in the fields below to get started.

The User Name entered must be unique to all of the Delta Dental websites.

User Name:
 
Office TIN:
License Number:
Doctor's First Name:
Doctor's Last Name:
User's First Name:
User's Last Name:
License State:


    Address Information

    Address and Contact Information
    Street Address:
    Street Address 2:
    City:
    State:
    Zip:
    Please contact Provider Services if the address information listed above is incorrect.
    Northeast Delta Dental will use your email only to provide you with information of interest from the Northeast Delta Dental family of companies. Northeast Delta Dental will not sell your email address or provide it to other outside entities.
    Current E-Mail Address:
    Office Telephone:
    Please choose a unique password that will identify you when you sign on. Please remember that passwords are case sensitive.
    Special characters are allowed except the following: % and &
    Password (8-20 char):
    Retype Password:
    To help us identify you in case you forget your password in the future: Choose a question to which you will remember the answer:
    Select Security Question:
    Security Answer:

      Terms of Service Agreement

      Terms

        Finish

        Finish
        Registration Complete
        Thank you for registering.
        Registration NOT Complete