Select Your Primary Care Dentist

Fill out this form so we can help assign your Primary Care Dentist (PCD) for the SoonerSelect Dental Program. Complete one form for each member of your household who is a DentaQuest Plan member.

Find your Primary Care Dentist information by using our find a dentist tool.

Please briefly explain your license request below

Member Information

First Name

Last Name

Date of Birth

Phone Number (used at sign up)

Medicaid Member ID

Dental Plan SoonerSelect Dental Program

Provider Information

Please provide the following information so we can help assign your Primary Care Dentist. You can find your Primary Care Dentist information by using our find a dentist tool.

Provider Name

Office/Location Name

Office/Location Address

Last modified on January 3, 2024

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PREVENTISTRY PULSE

A newsletter with tips and information to improve your oral health.