Apply for the Select Dental Plan

To apply for the Select Dental Plan from Stuart Curry Dentistry online, please fill in the fields below. We will notify you as soon as your payment has been processed and your plan has been activated.

If you do not feel comfortable submitting your information online, you may print the Select Dental Plan application form (PDF), fill it out on your own, and bring it to our office.

Feel free to contact us with any questions.

Application

Please fill in the fields below. We will notify you once your payment has been accepted and your dental insurance has been activated.

Please list all dependents to be covered (one per line). Spouses and children Under 21 are eligible on your plan. The cost is $20 per month, per dependent, or pay $200 annually per dependent and save.

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Proceed if paying by credit card. If paying by cash or check, come by our office or mail your check (address). You will still need to submit this application whether you pay by card, check, or cash.