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Oral Health Care Gives You A Choice of Several Plans:
Maxi-Dent, Maxi-Dent Plus, Ortho-Rider

  Maxi-Dent Plus "The Best" Maxi-Dent
(Plan B)
Ortho-Rider (Additional)
Individual Only $30.00 $25.00 + $10.00
Individual Plus One $45.00 $35.00 + $16.00
Family (upto 3)
(add $9/person over 3)
$51.00 $40.00 + $20.00

One-time Processing fees $20.00 $20.00 + $16.00

Enrollment Information
First Name:
Last Name:
Street:
Dentists are ONLY available in the following cities: Kansas City, St. Louis, and Wichita.
City:
State:
Zipcode:
(Phone) Home: Work: Cell:
E-Mail:

Select Closest Metro City
City:
State:

Kansas City, Kansas Dentists
 Kansas City, Ks  Lenexa, Ks
Rose, Tommy DDS Berkvam, Dawn DDS
 753 State Ave  10127 Cherry Lane
 Suite #402, 66101  64106 - Downtown area

 Leawood, Ks  Shawnee Mission, Ks
Schwartz, Barry DDS Jordan, John DDS
 8012 Stateline Rd  7501 Mission Rd
 Suite #101, 66208  66208
Kansas City, Missouri Dentists
 Kansas City, Mo  Kansas City, Mo  Kansas City, Mo
Berkvam, Dawn DDS Bishop, Charles W. DDS Johnson-Lambert, An DDS
 1010 Walnut St  7211 NW 83rd St  3715 E. Gregory
 64106 - Downtown area  Suite #120 (Airport area)  64110

 Kansas City, Mo  Kansas City, Mo
Meyers, Sere S. DDS Schwartz, Barry DDS
 5240 Prospect  8012 Stateline Rd
 64130  Suite #101, 66208

 Lee's Summit, Mo  Raytown, Mo  Raytown, Mo
Afzali, Mojan DDS Goodheart, Tim DDS
 511 SW Jefferson  Raytown Rd
 64063  Suite #A, 64133
Wichita, Kansas Dentists
 Wichita, Ks
Williams, Charlotte DDS
 2010 E 21st Street North    
 67214    

St. Louis, Missouri Dentists
 St. Louis, Mo  Mid-town St. Louis, Mo  North County, Mo
Pang, Alan W. DDS Plaza Dental, Green DDS A.V. Harper DDS
 6651 Chippewa Suite #212  4646 Lindell  6830 Natural Bridge
 St. Louis, 63109  St. Louis, 63108  St. Louis, 63121

 South County, Mo  West County, Mo  East St. Louis, Il
Richard Squires DDS Stewart M. Sheinbein DDS Raymond Routier DDS
 4630 Graavois Rd  1921 Schutz Rd  3116 State St.
 St. Louis, 63116  St. Louis, 63146  E. St. Louis, IL 62205

 Clayton, Mo  Jefferson County, Mo
Marshall Freerks DDS Steven Cajigal DDS
 6744 Clayton Rd Suite 204  838 Arnold Commons
 Clayton, Mo 63117  Arnold, Mo 63010

Select Plan: Ortho-Rider? Yes
Spouse
First name: Last: Gender:
Street Address: Apt.: Age:
(Phones) Work: Cell:

Child(ren)
Child #1
First name: Last: Gender:
Street Address: Apt.: Age:
Child #2
First name: Last: Gender:
Street Address: Apt.: Age:
Child #3
First name: Last: Gender:
Street Address: Apt.: Age:
Child #4
First name: Last: Gender:
Street Address: Apt.: Age:
Child #5
First name: Last: Gender:
Street Address: Apt.: Age:
Child #6
First name: Last: Gender:
Street Address: Apt.: Age:
Child #7
First name: Last: Gender:
Street Address: Apt.: Age:
Child #8
First name: Last: Gender:
Street Address: Apt.: Age:
Plan Selection Details
Plan: Covering:
One-time Processing Fee: Payment: Total:
 

Kansas Home Office at (316) 529-3330 or 1-800-525-8869

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