Customer Service for TRICARE Dental Program

To get assistance with your TRICARE Dental Program questions, please complete the secure form below.

* Required Fields

	Personal Information
	First Name*	>> Required
	Last Name*	>> Required
	Member ID*	Note: This can be your SSN or DEERS Beneficiary Number>> Required
	Relationship*	>> Required

	Contact Information
	Address*	>> Required
	City*	>> Required
	State	>> Required
	Zip/Postal Code	>> Required
	Country	>> Required
	Phone*	>> Required> Include country code if outside US.
	Email *	>> Invalid email
	Contact Type*	>> Required
	Comments/Questions*	Comments/Questions >> Required

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