The Forms Most Commonly Used By Savon Dental Plan Providers

All but one of these forms are in a PDF format, so you need to have Adobe® Acrobat Reader.  If you do not have it, you may download it for free at www.acrobat.com.

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Forms completed in the PDF format may be mailed to Savon at PO Box 54277, Phoenix, AZ 85078 or scanned and emailed to ProviderServices@SavonDentalPlan.com.
Forms that were downloaded in the Excel format should be emailed to ProviderServices@SavonDentalPlan.com.

Urban and Rural fee schedules for each state
Download the official, full color Schedule of Benefits for your State
Existing Providers Only - Add Another Dentist (General and Specialists) To Existing Center
Add A General Dentist To An Existing Facility
Add A Specialist To An Existing Speciality Facility
Existing Providers Only - Add A New Dental Center And Dentists (General and Specialists)
Add Another Dental Facility (General Or Specialists)
Add Another General Dentist And Facility
Add Another Specialist And Speciality Facility

Have a question or comment?  Email provider services or call us at 1-602-841-3494.