To begin the dental plan application process, PRINT THIS FORM, fill it out, and mail it along with your enrollment fees.  You will receive your membership packet by return mail. For immediate enrollment call (888) 550-8895 during regular business hours.  Enroll online now.

Same Day Coverage- 10 Minute Enrollment
Save up to 70% - Same Day or Next Day Appointments

Call now toll free (888) 550-8895 for more information, for a free, no
obligation quote and/or to enroll over the phone with a credit card.

Yearly Enrollment Fees

Save Money On Your Yearly Enrollment...To save money on your yearly dental enrollment fees, sign up additional people with the first enrollment.  For example, up to six people can enroll for $155.   They don't have to live at the same address, nor do they have to be related. That brings down the yearly enrollment fee to a little more than $25 per person (saving nearly 50%).  Group enrollment packages can include family, friends, co-workers, neighbors or anyone without dental insurance who may need dental coverage.  
 

Mail enrollment form and fees to the following.

Affordable Care Dental Plan, Inc.
3431 Pomona Blvd  Unit B
Pomona, CA 91768

Affordable Care Dental Plan Enrollment Form
Name of Primary Member:
Mailing Address:
City, State, Zip:
Telephone:
Date:

Email Address:

     Names of additional family members to be included in the plan.
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Comments: