Federal Housing Finance Agency (FHFA)
Customer Service Online Inquiry Form

Are you a dentist? Please use our Online Dentist Inquiry Form.

Are you enrolled? Register now on our Member Portal.

REQUESTOR INFORMATION

Fields marked with an asterisk (*) are required.

First Name*

Last Name*

Email Address*

Requestor Status*

Enrolled Not Enrolled

SUBSCRIBER INFORMATION

Same as above (auto populate the subscriber first and last name)

Subscriber First Name*

Subscriber Last Name*

Subscriber Date of Birth*

Subscriber ID*

NATURE OF INQUIRY

Are you inquiring about a claim?*

No Yes

Claim Number*

The 13-digit Claim Number is located in the upper right portion of your Explanation of Benefits.

I would like to recommend my dentist to participate in the Delta Dental Provider Network.

Dentist First Name*

Dentist Last Name*

Dentist Business Name

Dentist Address*

Dentist City*

Dentist State*

Dentist Specialty*

Dentist Zip Code*

INQUIRY DETAILS

Inquiry Details*

ATTACHMENTS

Up to THREE files may be attached per inquiry. Maximum file size is 15MB.

Accepted file types are doc, docx, xls, xlsx, xlsm, pdf, txt, jpg, jpeg, tif and tiff.

Federal Housing Finance Agency (FHFA)Customer Service Online Inquiry Form