Contact Us Grievances

LIBERTY Dental Plan

3200 El Camino Real, Suite 290
Irvine, CA 92602
(888) 703-6999
(949) 223-0007
Fax (949) 223-0011

Submit a Grievance
Member Name (required)	Plan Name
Member Home Address (required)	Group Name
City(required)	State(required)
Zip Code(required)
Home Phone Number (required)
Work Phone Number
Member E-mail Address(required)
Dentist/Facility Name (required)	Dental Office ID Number
Complaint (Please document as much as possible)
Recommendation (Action requested by user)
Download PDF Grievance Form