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We at LIBERTY Dental Plan have created many of our plans and programs based on input from the broker community.

To join LIBERTY Dental
Please call to enroll or fill out the applications below.

Call Marsha Hazlewood at 1-888-703-6999 or download our applications below in PDF format.
Broker Application
W-9 Form
Mail forms to:
ATTN: Marsha Hazlewood
LIBERTY Dental Plan of California, Inc.
3200 El Camino Real, Suite 290
Irvine, CA 92602

 
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