Delta Dental of New Mexico

Forms

To request a copy of a dental claim form, please call Customer Service at (877) 395-9420 or send an email to customerservice@deltadentalnm.com.
 
Mail completed paper claims to:
 
Delta Dental of New Mexico
100 Sun Avenue NE, Suite 400
Albuquerque, NM 87109
  • Provider Association Form: Active Delta Dental Participating Providers can use this form to add a new office location without needing to fill out the full Provider Credentialing Profile.
  • Practice Information Update Form: Use this form to notify Delta Dental of New Mexico about changes to practice information, such as the street address or office hours.
  • Provider Termination Form: Use this form to notify Delta Dental of New Mexico about a provider who is no longer working at your practice.

Automated Phone System Reference