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Alpha Dental Plan of Colorado Employee Enrollment Packet BBB Rating: A+ 9725 East Hampden Avenue, Suite #400, Denver, CO 80231 1-800-807-0706 www.betadental.com

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Page 1: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alpha Dental Plan of Colorado

Employee Enrollment Packet

BBB Rating: A+

9725 East Hampden Avenue, Suite #400, Denver, CO 80231 1-800-807-0706

www.betadental.com

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Plan HighlightsCosmetic dentistry included

No waiting on any services

Orthodontics (braces) discounted for children and adults

No forms to complete

No age limits for members

No limit on visits

No exclusions for dental health conditions

No limits on access to discounts (use as much as you like each year)

Guaranteed acceptance

The following fee schedule represents the pre-negotiated discounts that have been arranged in advance with the dental providers that are participating in the network. Simply pay these amounts directly to these network providers at the time services are rendered…it’s that easy! There are no forms to complete.

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ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION

NORMAL FEE

ALPHA PLAN #19 YOU SAVE

999 ROUTINE OFFICE VISIT 35$ 5$ 86%120 PERIODIC ORAL EVALUATION 53$ NO COST 100%140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED 79$ 15$ 81%150 COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED PATIENT 97$ 12$ 88%210 X-RAY INTRAORAL COMPLETE SERIES INC. BITEWINGS 134$ 29$ 78%220 X-RAY INTRAORAL-PERIAPICAL-FIRST FILM 31$ 6$ 81%230 X-RAY INTRAORAL PERIAPICAL EACH ADDITIONAL FILM 26$ 5$ 81%240 X-RAY INTRA ORAL-OCCLUSAL FILM 48$ 5$ 90%250 X-RAY EXTRAORAL-FIRST FILM 75$ 5$ 93%260 X-RAY EXTRAORAL-EACH ADDITIONAL FILM 63$ 5$ 92%270 X-RAY BITEWING-SINGLE FILM 31$ NO COST 100%272 X-RAY BITEWING-2 FILMS 48$ NO COST 100%274 X-RAY BITEWING-4 FILMS 68$ NO COST 100%330 X-RAY PANORAMIC FILM 116$ 49$ 58%340 CEPHALOMETRIC FILM 137$ 60$ 56%460 PULP VITALITY TEST 61$ NO COST 100%470 DIAGNOSTIC CASTS 122$ 49$ 60%999 EMERGENCY VISIT (SAME DAY) 90$ 25$ 72%

1110 PROPHYLAXIS-ADULT CLEANING (EVERY 6 MONTHS) 96$ 15$ 84%1120 PROPHYLAXIS-CHILD CLEANING (EVERY 6 MONTHS) 72$ 15$ 79%1203 TOPICAL APPLICATION OF FLUORIDE NOT INCL/PROPHY-CHILD 39$ 11$ 72%1330 ORAL HYGIENE INSTRUCTIONS 63$ NO COST 100%1351 SEALANT PER TOOTH 58$ 12$ 79%1510 SPACE MAINTAINER FIXED UNILATERAL 338$ 173$ 49%1515 SPACE MAINTAINER FIXED BILATERAL 461$ 250$ 46%1520 SPACE MAINTAINER-REMOVABLE-UNILATERAL 418$ 213$ 49%1525 SPACE MAINTAINER-REMOVABLE-BILATERAL 522$ 246$ 53%1550 RE-CEMENTATION OF SPACE MAINTAINER 90$ 17$ 81%1999 ADDITIONAL PROPHY (FOR PERIO MAINTENANCE) 96$ 41$ 57%

2140 AMALGAM-1 SURFACE (PRIMARY OR PERMANENT) 150$ 33$ 78%2150 AMALGAM-2 SURFACES (PRIMARY OR PERMANENT) 195$ 44$ 77%2160 AMALGAM-3 SURFACES (PRIMARY OR PERMANENT) 232$ 54$ 77%2161 AMALGAM-4 OR MORE SURFACES (PRIMARY OR PERMANENT) 272$ 63$ 77%2330 RESIN BASED COMPOSITE 1 SURFACE (ANTERIOR) 169$ 45$ 73%2331 RESIN BASED COMPOSITE 2 SURFACES (ANTERIOR) 212$ 58$ 73%2332 RESIN BASED COMPOSITE 3 SURFACES (ANTERIOR) 264$ 77$ 71%2335 RESIN 4 OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR) 328$ 124$ 62%2390 RESIN BASED COMPOSITE CROWN ( ANTERIOR) 476$ 262$ 45%2391 RESIN BASED COMPOSITE ONE SURFACE (POSTERIOR) 188$ 98$ 48%2392 RESIN BASED COMPOSITE TWO SURFACE (POSTERIOR) 243$ 135$ 44%2393 RESIN BASED COMPOSITE THREE SURFACE (POSTERIOR) 305$ 172$ 44%2394 RESIN BASED COMPOSITE FOUR OR MORE SURFACES (POSTERIOR) 364$ 188$ 48%

*2510 INLAY-METALLIC-ONE SURFACE 906$ 299$ 67%*2520 INLAY-METALLIC-TWO SURFACE 936$ 309$ 67%*2530 INLAY-METALLIC-THREE OR MORE SURFACES 991$ 327$ 67%*2542 ONLAY-METALLIC-TWO SURFACES 1,005$ 332$ 67%*2543 ONLAY-METALLIC-THREE SURFACES 1,037$ 343$ 67%*2544 ONLAY-METALLIC-FOUR OR MORE SURFACES 1,069$ 352$ 67%*2610 INLAY-PORCELAIN/CERAMIC-ONE SURFACE 965$ 318$ 67%*2650 INLAY-RESIN BASED COMPOSITE-ONE SURFACE 927$ 306$ 67%*2651 INLAY-RESIN BASED COMPOSITE-TWO SURFACES 952$ 314$ 67%*2652 INLAY-RESIN BASED COMPOSITE-THREE OR MORE SURFACES 993$ 328$ 67%*2710 CROWN-RESIN BASED COMPOSITE (INDIRECT) 963$ 319$ 67%*2720 CROWN-RESIN WITH HIGH NOBLE METAL 1,139$ 375$ 67%*2721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL 1,032$ 340$ 67%*2722 CROWN RESIN WITH NOBLE METAL 1,048$ 346$ 67%*2740 CROWN PORCELAIN/CERAMIC SUBSTRATE 1,196$ 395$ 67%*2750 CROWN PORCELAIN FUSED TO HIGH NOBLE METAL 1,164$ 384$ 67%*2751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 1,054$ 315$ 70%*2752 CROWN-PORCELAIN FUSED TO NOBLE METAL 1,091$ 370$ 66%

Page 1

Diagnostic Services (Exams and X-rays)

Preventive Services (Cleanings)

Restorative Services (Fillings, Crowns, Inlays and Onlays)

Current Dental Terminology ©American Dental Association

Beta Health Association, Inc.Dental Fee Schedule

Alpha Plan #19Form 7109

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ADACODE DENTAL PROCEDURE/ADA CODE DESCRIPTION

NORMALFEE

ALPHAPLAN #19 YOU SAVE

*2790 CROWN FULL CAST HIGH NOBLE METAL 1,154$ 366$ 68%*2791 CROWN FULL CAST PREDOMINANTLY BASE METAL 1,028$ 318$ 69%*2792 CROWN FULL CAST NOBLE METAL 1,058$ 345$ 67%2910 RECEMENT INLAY, ONLAY, OR PARTIAL COVERAGE RESTORATION 116$ 15$ 87%2920 RECEMENT CROWN 116$ 31$ 73%2930 PREFAB. STAINLESS STEEL CROWN-PRIMARY 291$ 101$ 65%2931 PREFAB STAINLESS STEEL CROWN-PERMANENT 355$ 123$ 65%2932 PREFAB. RESIN CROWN 376$ 157$ 58%2933 PREFAB. STAINLESS STEEL CROWN WITH RESIN WINDOW 398$ 179$ 55%2940 SEDATIVE FILLING 132$ 37$ 72%2950 CORE BUILDUP INCLUDING ANY PINS 292$ 82$ 72%2951 PIN RETENTION PER TOOTH IN ADD. TO RESTORATION 81$ 23$ 72%2952 CAST POST & CORE IN ADDITION TO CROWN 456$ 134$ 71%2954 PREFAB POST & CORE IN ADDITION TO CROWN 365$ 107$ 71%2955 POST REMOVAL (NOT IN CONJUNCTION WITH ENDODONTIC THERAPY) 317$ 139$ 56%2960 LABIAL VENEER RESIN LAMINATE (CHAIRSIDE) 714$ 187$ 74%2999 BLEACHING (PER ARCH) 270$ 162$ 40%2999 $125 ADDTL.CHARGE P/UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION

3110 PULP CAP DIRECT EXCLUDING FINAL RESTORATION 90$ 26$ 71%3120 PULP CAP INDIRECT EXCLUDING FINAL RESTORATION 93$ 27$ 71%3220 THERAPEUTIC PULPOTOMY EXCLUDING FINAL RESTORATION 218$ 72$ 67%3230 PULPAL THERAPY ANTERIOR, PRIMARY TOOTH EXCLUDING REST. 328$ 102$ 69%3240 PULPAL THERAPY POSTERIOR, PRIMARY TOOTH EXCLUDING REST 370$ 113$ 69%3310 ROOT CANAL THERAPY 1 CANAL (EXCLUDING FINAL RESTORATION) 778$ 275$ 65%3320 ROOT CANAL THERAPY 2 CANALS (EXCLUDING FINAL RESTORATION) 874$ 320$ 63%3330 ROOT CANAL THERAPY 3 CANALS OR MORE 1,058$ 400$ 62%3410 APICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR 741$ 328$ 56%3421 APICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT) 805$ 366$ 55%3425 APICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT) 950$ 424$ 55%3426 APICOECTOMY/PERIRADICULAR SURGERY-EACH ADDITIONAL ROOT 450$ 161$ 64%3430 RETROGRADE FILLING-PER ROOT 315$ 116$ 63%3910 SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM 279$ 64$ 77%

4210 GINGIVOPLASY OR GIGIVECTOMY- 4+ CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD 704$ 333$ 53%4211 GINGIVECTOMY OR GINGIVOPLASTY-1 TO 3 CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD 323$ 178$ 45%4240 GINGIVAL FLAP PROCEDURE, INCL.ROOT PLNG -4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD 820$ 352$ 57%4260 OSSEOUS SURG. INCL. FLAP ENTRY & CLOSURE-4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD 1,138$ 521$ 54%4320 PROVISIONAL SPLINTING-INTRACORNIAL 556$ 260$ 53%4321 PROVISIONAL SPLINTING-EXTRACORNIAL 527$ 246$ 53%4341 PERIODONTAL SCALING & ROOT PLNG- 4+ TEETH PER QUAD 265$ 112$ 58%4355 FULL MOUTH DEBRIDEMENT TO ENABLE COMP.EVAL. & DIAGNOSIS 197$ 89$ 55%4910 PERIODONTAL MAINTENANCE 146$ 57$ 61%4999 PERIO SCREENING AND SCORING 30$ 10$ 67%

5110 COMPLETE DENTURE-MAXILLARY 1,799$ 533$ 70%5120 COMPLETE DENTURE-MANDIBULAR 1,799$ 533$ 70%5130 IMMEDIATE DENTURE-MAXILLARY 1,921$ 764$ 60%5140 IMMEDIATE DENTURE-MANDIBULAR 1,958$ 778$ 60%5211 MAXILLARY PART. DENTURE-RESIN BASE (INCL. CLASPS & TEETH) 1,474$ 463$ 69%5212 MANDIBULAR PARTIAL DENTURE-RESIN BASE (INCL. CLASPS & TEETH) 1,448$ 442$ 69%5213 MAXILLARY PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) 1,885$ 547$ 71%5214 MANDIBULAR PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) 1,889$ 545$ 71%5410 ADJUST COMPLETE DENTURE-MAXILLARY 96$ 36$ 63%5411 ADJUST COMPLETE DENTURE-MANDIBULAR 95$ 36$ 62%5421 ADJUST PARTIAL DENTURE-MAXILLARY 95$ 36$ 62%5422 ADJUST PARTIAL DENTURE-MANDIBULAR 95$ 36$ 62%5510 REPAIR BROKEN COMPLETE DENTURE BASE 231$ 88$ 62%5520 REPLACE MISSING OF BROKEN TEETH-COMP.DENTURE-EACH TOOTH 197$ 62$ 69%5610 REPAIR RESIN DENTURE BASE 225$ 82$ 64%5620 REPAIR CAST FRAMEWORK 313$ 139$ 56%5630 REPAIR OR REPLACE BROKEN CLASP 286$ 105$ 63%5640 REPLACE BROKEN TEETH-PER TOOTH 198$ 68$ 66%5650 ADD TOOTH TO EXISTING PARTIAL DENTURE 241$ 93$ 61%5660 ADD CLASP TO EXISTING PARTIAL DENTURE 292$ 121$ 59%

Page 2

Restorative Services (Fillings, Crowns, Inlays and Onlays) Con't

Endodontic Services (Root Canals)

Periodontic Services (Gum Disease)

Prosthodontics (Removable/Complete Dentures, etc.)

Current Dental Terminology ©American Dental Association

*These co-payments do not include an allowable $151 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fees. Temporary crowns are included with permanent crown preparation.

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ADACODE DENTAL PROCEDURE/ADA CODE DESCRIPTION

NORMALFEE

ALPHAPLAN #19 YOU SAVE

5710 REBASE COMPLETE MAXILLARY DENTURE 630$ 276$ 56%5711 REBASE COMPLETE MANDIBULAR DENTURE 629$ 276$ 56%5720 REBASE MAXILLARY PARTIAL DENTURE 609$ 230$ 62%5721 REBASE MANDIBULAR PARTIAL DENTURE 609$ 231$ 62%5730 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) 402$ 175$ 56%5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) 402$ 175$ 56%5740 RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) 397$ 167$ 58%5741 RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) 402$ 167$ 58%5750 RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) 503$ 155$ 69%5751 RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) 503$ 155$ 69%5760 RELINE MAXILLARY PARTIAL DENTURE (LABORATORY) 503$ 158$ 69%5761 RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY) 503$ 157$ 69%5850 TISSUE CONDITIONING MAXILLARY 231$ 66$ 71%5851 TISSUE CONDITIONING MANDIBULAR 233$ 65$ 72%

*6210 PONTIC-CAST HIGH NOBLE METAL 1,133$ 359$ 68%*6211 PONTIC-CAST PREDOMINANTLY BASE METAL 1,037$ 303$ 71%*6212 PONTIC-CAST NOBLE METAL 1,075$ 320$ 70%*6240 PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL 1,161$ 383$ 67%*6241 PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 1,058$ 312$ 71%*6242 PONTIC-PORCELAIN FUSED TO NOBLE METAL 1,084$ 331$ 69%*6250 PONTIC-RESIN WITH HIGH NOBLE METAL 1,085$ 345$ 68%*6251 PONTIC-RESIN WITH PREDOMINANTLY BASE METAL 1,042$ 323$ 69%*6252 PONTIC-RESIN WITH NOBLE METAL 1,044$ 325$ 69%*6720 CROWN-RESIN WITH HIGH NOBLE METAL 1,154$ 380$ 67%*6721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL 1,042$ 344$ 67%*6722 CROWN-RESIN WITH NOBLE METAL 1,067$ 352$ 67%*6750 CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL 1,164$ 384$ 67%*6751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 1,052$ 315$ 70%*6752 CROWN-PORCELAIN FUSED TO NOBLE METAL 1,079$ 335$ 69%*6790 CROWN-FULL CAST HIGH NOBLE METAL 1,133$ 359$ 68%*6791 CROWN-FULL CAST PREDOMINANTLY BASE METAL 1,042$ 323$ 69%*6792 CROWN-FULL CAST NOBLE METAL 1,084$ 330$ 70%6930 RECEMENT FIXED PARTIAL DENTURE 185$ 69$ 63%

7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) 185$ 46$ 75%7210 SURGICAL EXT. ERUPTED TOOTH WITH REMOVAL OF BONE 295$ 81$ 73%7220 REMOVAL OF IMPACTED TOOTH-SOFT TISSUE 345$ 92$ 73%7230 REMOVAL OF IMPACTED TOOTH PARTIALLY BONY 419$ 163$ 61%7240 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY 524$ 210$ 60%7241 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY W/ UNUSUAL SURG. COMPLICATION 635$ 248$ 61%7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) 322$ 118$ 63%7270 TOOTH REIMPL. AND/OR STAB. OF ACC.EVULSED OR DISPL. TOOTH 609$ 243$ 60%7280 SURGICAL ACCESS OF AN UNERUPTED TOOTH 540$ 235$ 56%7285 BIOPSY OF ORAL TISSUE-HARD (BONE-TOOTH) 497$ 217$ 56%7286 BIOPSY OF ORAL TISSUE-SOFT 344$ 150$ 56%7310 ALVEOPLASTY IN CONJ. WITH EXT.- PER QUAD 329$ 126$ 62%7320 ALVEOPLASTY NOT IN CONJ WITH EXT- PER QUAD 528$ 195$ 63%7510 INCISION AND DRAINAGE ABSCESS- INTRAORAL SOFT TISSUE 255$ 99$ 61%7910 SUTURE OF RECENT SMALL WOUNDS UP TO 5CM 341$ NO COST 100%7960 FRENULECTOMY (FRENECTOMY OR FRENOTOMY)- SEPARATE PROCEDURE 498$ 128$ 74%7970 EXCISION OF HYPERPLASTIC TISSUE- PER ARCH 582$ 207$ 64%

9110 EMERGENCY PALATIVE TREATMENT OF DENTAL PAIN- MINOR PROCEDURE 138$ 48$ 65%9230 ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE - FIRST 30 MINUTES 95$ 27$ 72%9310 CONSULTATION (DIAG. SERV. PROV. BY DENTIST OR PHYSICIAN OTHER THAN PRACTIONER PROV. TREATMNT) 159$ NO COST 100%9910 APPLICATION OF DESENSITIZING MEDICAMENT 73$ 6$ 92%9941 FABRICATION OF ATHLETIC MOUTHGUARD 315$ 107$ 66%9951 OCCLUSAL ADJUSTMENT-LIMITED 212$ 77$ 64%9952 OCCLUSAL ADJUSTMENT-COMPLETE 770$ 286$ 63%9999 MISSED APPOINTMENT (WITHOUT 24 HOUR NOTICE) 54$ 30$ 44%

Page 3

Prosthodontics (fixed/Partial Dentures, etc.)

Oral Surgery (Extractions, etc.)

General Miscellaneous Services

Current Dental Terminology ©American Dental Association

Prosthodontics (Removable/ Complete Dentures, etc.) Con't

NOTE: In addition to the fees listed above in section 5000 thru 6000, additional fees may be charged for upgraded teeth and enhanced cosmetics, personalization beyond norm or techniques involving precision dentures.

*These co-payments do not include an allowable $151 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fee.

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ADACODE DENTAL PROCEDURE/ADA CODE DESCRIPTION

NORMALFEE

ALPHAPLAN #19 YOU SAVE

13 MONTH TREATMENT PLAN ($137/MONTH) 3,114$ 2,409$ 23%16 MONTH TREATMENT PLAN ($137/MONTH) 3,625$ 2,820$ 22%19 MONTH TREATMENT PLAN ($137/MONTH) 4,135$ 3,231$ 22%22 MONTH TREATMENT PLAN ($137/MONTH) 4,606$ 3,642$ 21%25 MONTH TREATMENT PLAN ($137/MONTH) 5,158$ 4,053$ 21%28 MONTH TREATMENT PLAN ($137/MONTH) 5,669$ 4,464$ 21%31 MONTH TREATMENT PLAN ($137/MONTH) 6,179$ 4,875$ 21%34 MONTH TREATMENT PLAN ($137/MONTH) 6,690$ 5,286$ 21%36 MONTH TREATMENT PLAN ($137/MONTH) 6,951$ 5,560$ 20%

Page 4

Current Dental Terminology ©American Dental Association

Orthodontics (Braces) for Children & Adults Monthly Payment

Other Orthodontic Guidelines

1. A $382 charge will apply at the end of treatment (included in the above amounts) to cover all retention office visits(unlimited).

2. Services not listed above will be discounted 30% off of the participating Orthodontist's Usual and Customary fees (except #5listed below).

3. Services must only be provided by a contracted Orthodontic Specialist.4. The amounts listed above also include an initial one-time $246 charge for all records, mold, x-rays, etc. to determine

the Orthodontic Treatment for the patient.5. Invisalign® procedures are to be discounted 15% off the participating Orthodontist's Usual and Customary fees.____________________________________________________________________________________________

All Plans General Limitations and Exclusions

1. All fees listed above do not include all appropriate lab fees. Member must agree (in writing) to all upgraded materialsbefore treatment is started. See each section for specific details (if applicable).

2. All patients are responsible for paying all fees (as listed above) at the time services are rendered.3. These fees are for General Dentists only. A participating specialist list is available by calling our office at

303-744-3007 or 1-800-807-0706. 4. Any procedures not listed will be discounted 20% off the participating General Dentists normal fees.5. Medical costs associated with any dental procedures are not covered.6. Dentures or appliances will be replaced only after 3 years have elapsed since such dentures or appliances were

provided under any plan program, unless the denture or appliance becomes unserviceable due to illness or other causesnot controlled by other means. Replacement of dentures, appliances, or bridgework due to loss or theft are not covered.

7. Any dental treatment started prior to the Member's eligibility to receive services under this plan or started after a Member's termination are not covered.

8. Failure to follow the prescribed treatment or accidents occurring during the course of treatment may result in additional charges by your plan provider.

9. Failure to pay scheduled fees at the time service is rendered may prevent future dental services from being received until all fees have been paid in full.

10. Services provided by non-participating dentists are not covered. 11. Services which, in the opinion of the attending dentist, are not necessary for the patient's dental health, or are contrary to

established dental ethics are not covered.12. Cosmetic dental procedures are covered only if the attending dentist and patient agree on the specific procedure.13. Services which are compensable under Worker's Compensation or employer liability laws are not covered.14. General anesthesia and IV sedation are not covered.15. Myofunctional therapy procedure for training, treating or developing muscles in and around the jaw or mouth including TMJ

are not covered except by participating plan specialists.16. Any dental procedure or service that cannot be performed in the dental office due to general and/or physical limitations of a

member are not covered.17. Expenses incurred for dental procedures initiated prior to member's eligibility or after termination are not covered.18. Any services that the Participating General Dentist recommends be performed by a specialist are covered only by a plan

participating specialist.19. The liability of Beta Health Association, Inc. is limited to the return of the membership fees paid for one year by the member.20. Extractions for asymptomatic third molars (wisdom teeth) are not covered unless causing movement of the teeth. An

example of symptomatic include severe decay, and ontogenic cysts, chronic pericoronitis, and infection. 21. The Beta Health Association, Inc. dental programs do not constitute dental insurance and are considered discount, fee-for-

service dental plans.22. Fees are subject to change on an as needed basis. Please contact Beta Health Association, Inc. for current fees.

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Three Easy Ways

To find an Alpha Dental Plan Provider

1. Use the Provider Directory provided to you in the enrollment packet. You must select a provider when enrolling. The number in column 3 of the directory needs to be placed to the right of the Alpha Dental Plan selection on the enrollment form. You can change providers at any time. All family members must see the same provider for treatment.

2. Go to www.betadental.com/alpha19/ and enter the zip code of where you wish to see a participating Alpha Dental Plan provider.

3. Call our office at (303)744-3007 or 1(800)807-0706 for assistance. We are here to help!

Important:

All services received while you are enrolled in the Alpha Dental Plan MUST be provided by a participating Alpha Dental Plan provider or

dental office. Non network provider services are not available.

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enta

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Jack

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231

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Jeffr

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P #

254

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Juan

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DP

#62

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lpha

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lan

incl

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pro

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sted

in a

lpha

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dat

e pr

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at w

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cal

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Pag

e 1

of 2

4

Page 9: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Jam

es R

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rvad

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Roy

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riot

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P #

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P #

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Pag

e 2

of 2

4

Page 10: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Ger

ald

Edw

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fort

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tal -

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ora

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P #

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Gen

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tist

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as E

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iel

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Thom

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P #

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DP

#74

3551

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, #c

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#74

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, #c

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DP

#74

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, #c

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A

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DP

#74

3551

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, #c

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ora

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eral

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tist

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2

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one

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enta

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Pag

e 3

of 2

4

Page 11: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Mat

thew

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ngBr

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Now

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tal -

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DP

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, #c

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eral

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tist

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#74

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Pag

e 4

of 2

4

Page 12: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Chr

isto

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197

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. Aca

dem

y B

lvd.

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7599

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rings

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eral

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n P

ini

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108

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olor

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AD

P #

118

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AD

P #

118

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ers

AD

P #

118

6076

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ua B

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ers

AD

P #

118

6076

Ste

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d.71

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4

Pag

e 5

of 2

4

Page 13: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Dan

Kin

gsfo

rdC

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rt D

enta

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ustin

Blu

ffs A

dpA

DP

#15

839

52 N

orth

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dem

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591-

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rings

Gen

eral

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tist

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, E1-

2, E

3-4

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rick

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son

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fort

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AD

P #

158

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4

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my

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lock

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DP

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eral

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Pag

e 6

of 2

4

Page 14: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Thom

as M

ulhe

ran

Brig

ht N

ow D

enta

l - C

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right

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DP

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7-27

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omm

erce

City

Gen

eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Ram

sey

War

ner

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fort

Den

tal -

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mer

ce C

ityA

DP

#19

272

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onac

o S

t.30

3-28

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55C

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erce

City

Gen

eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Todd

Rin

aldi

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Rin

aldi

AD

P #

238

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nolia

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1-2,

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4

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Bra

ndon

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udB

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DS

.A

DP

#25

672

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City

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Den

tist

*, *

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1-2,

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Dr.

Jacq

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e Bl

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fort

Den

tal-C

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DP

#10

125

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Teni

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AD

P #

101

2559

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ifer

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eral

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tist

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, E1-

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3-4

Pag

e 7

of 2

4

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Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Gra

ce J

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fort

Den

tal-C

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DP

#10

125

597

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Jaso

n M

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AD

P #

101

2559

7 C

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r Rd.

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838-

2811

Con

ifer

Gen

eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Jam

es P

arfit

tC

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rt D

enta

l - M

ile H

igh

AD

P #

237

881

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eder

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0013

Den

ver

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eral

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tist

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, E1-

2, E

3-4

Dr.

Mat

thew

Car

lsto

nC

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rt D

enta

l - M

ile H

igh

AD

P #

237

881

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0013

Den

ver

Gen

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Den

tist

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, E1-

2, E

3-4

Dr.

Lyda

Mar

tinez

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fort

Den

tal -

Nor

th D

enve

rA

DP

#11

344

50 W

. 38t

h A

ve.,

#110

303-

455-

2273

Den

ver

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

John

Ada

ms

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fort

Den

tal -

Nor

th D

enve

rA

DP

#11

344

50 W

. 38t

h A

ve.,

#110

303-

455-

2273

Den

ver

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Rob

ert U

nrat

hC

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rt D

enta

l - N

orth

Den

ver

AD

P #

113

4450

W. 3

8th

Ave

., #1

1030

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1-2,

E3-

4

Dr.

Gar

y S

addl

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rt D

enta

l - N

orth

Den

ver

AD

P #

113

4450

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8th

Ave

., #1

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1-2,

E3-

4

Dr.

Ala

n C

oom

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Den

tal I

i, P

CA

DP

#12

1660

S. A

lbio

n, #

715

303-

758-

4287

Den

ver

Gen

eral

Den

tist

**

Dr.

Jaso

n R

ayH

ampd

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amily

Den

tal

AD

P #

124

7090

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ampd

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ve.,

#-A

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1113

Den

ver

Gen

eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Thom

as S

nieg

owsk

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Sni

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ski

AD

P #

151

7475

Dak

in S

t., S

te. #

309

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429-

2727

Den

ver

Gen

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Den

tist

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3-4,

N

Dr.

Mar

k Jo

lste

dC

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enta

l - C

herry

Cre

ekA

DP

#18

320

1 U

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rsity

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d., #

101

303-

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2233

Den

ver

Gen

eral

Den

tist

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2, E

3-4

Dr.

Todd

Lig

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l - C

herry

Cre

ekA

DP

#18

320

1 U

nive

rsity

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d., #

101

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2233

Den

ver

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Den

tist

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2, E

3-4

Dr.

Ric

hard

H. K

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entre

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enta

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DP

#20

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101

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ampd

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#100

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Den

ver

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Den

tist

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Dou

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DP

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101

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Den

ver

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eral

Den

tist

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2, E

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Mal

gorz

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R. K

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DP

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Jon

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P #

245

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8181

Den

ver

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Den

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3-4

Dr.

Am

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tal -

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DP

#24

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Mar

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AD

P #

245

3488

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8181

Den

ver

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tist

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Arn

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P #

248

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Dr.

Gar

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#26

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fax

AD

P #

2652

00 E

. Col

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Ave.

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377-

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ver

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tist

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, E1-

2

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Jeff

D. J

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ton

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ent D

enta

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upA

DP

#27

145

00 C

herry

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ek D

r. S

outh

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975-

6987

Den

ver

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tist

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3-4

Dr.

Thom

as P

yne

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Thom

as P

yne

AD

P #

2912

075

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5th

Ave

., #3

3330

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Dr.

Kris

tin L

ere

Brig

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ow D

enta

l - D

enve

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ntow

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dpA

DP

#30

1955

Ara

paho

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t., S

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303-

296-

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Den

ver

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Den

tist

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Thom

as M

ulhe

ran

Brig

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enta

l - D

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ntow

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dpA

DP

#30

1955

Ara

paho

e S

t., S

te. A

303-

296-

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Den

ver

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Den

tist

C, E

1-2,

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Man

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Pag

e 8

of 2

4

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Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Jack

F. E

mm

ons

Brig

ht N

ow D

enta

l - D

enve

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ntow

n A

dpA

DP

#30

1955

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paho

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t., S

te. A

303-

296-

0888

Den

ver

Gen

eral

Den

tist

C, E

1-2,

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Dav

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ryan

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Leig

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P #

3019

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right

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P #

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Dr.

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AD

P #

3019

55 A

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Jam

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enta

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dpA

DP

#30

1955

Ara

paho

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t., S

te. A

303-

296-

0888

Den

ver

Gen

eral

Den

tist

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4

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Sem

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Con

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ht N

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dpA

DP

#30

1955

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paho

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t., S

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303-

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0888

Den

ver

Gen

eral

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tist

C, E

1-2,

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Bar

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Dr.

Mic

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Dr.

Pau

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enta

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DP

#30

1955

Ara

paho

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t., S

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303-

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Den

ver

Gen

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Den

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Mat

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Yehi

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DP

#30

1955

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t., S

te. A

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Den

ver

Gen

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Den

tist

C, E

1-2,

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Dr.

Gilb

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DP

#30

1955

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paho

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t., S

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296-

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Den

ver

Gen

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Den

tist

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Dr.

Jeffr

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DP

#30

1955

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t., S

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303-

296-

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Den

ver

Gen

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Den

tist

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1-2,

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Cra

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DP

#30

1955

Ara

paho

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t., S

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303-

296-

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Den

ver

Gen

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Den

tist

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1-2,

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Dr.

Sam

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DP

#30

1955

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Den

ver

Gen

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Den

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Mar

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De

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#30

1955

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Den

ver

Gen

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Den

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Lind

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DP

#30

1955

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303-

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Den

ver

Gen

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Den

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Dr.

Lind

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DP

#47

3865

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303-

321-

1181

Den

ver

Gen

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Den

tist

C, N

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Pau

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Brig

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enta

l - C

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dpA

DP

#47

3865

Che

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reek

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200

303-

321-

1181

Den

ver

Gen

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Den

tist

C, N

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Mire

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right

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tal -

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AD

P #

4738

65 C

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Den

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1181

Den

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#47

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1181

Den

ver

Gen

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P #

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#47

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303-

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1181

Den

ver

Gen

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Den

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C, N

Pag

e 9

of 2

4

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Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

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DES

Dr.

Cha

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P #

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P #

4738

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Den

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Den

ver

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Kris

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Den

ver

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Julio

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Den

ver

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P #

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Tim

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#53

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Mic

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Pag

e 10

of 2

4

Page 18: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Arth

ur A

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bie

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tal-W

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P #

125

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P #

216

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Andr

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P #

216

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tist

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, E1-

2, E

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Dav

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AD

P #

216

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ve.,

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Fort

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lins

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Den

tist

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Rya

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AD

P #

216

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olle

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Fort

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lins

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Den

tist

*, *

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2, E

3-4

Dr.

Jam

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enta

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DP

#32

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8300

Fort

Col

lins

Gen

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Den

tist

C, E

1-2,

N

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Col

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AD

P #

3293

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P #

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P #

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enta

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DP

#38

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ve.,

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8706

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Den

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Geo

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970-

498-

8706

Fort

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Den

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ve.,

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Fort

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Yehi

a E

lgoh

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8706

Fort

Col

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right

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AD

P #

3835

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2

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Cra

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enta

l - F

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#38

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ge A

ve.,

#110

#5

970-

498-

8706

Fort

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lins

Gen

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Den

tist

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Jack

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mm

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enta

l - F

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DP

#38

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olle

ge A

ve.,

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970-

498-

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Fort

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Gen

eral

Den

tist

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Mar

iano

De

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DP

#38

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S. C

olle

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ve.,

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970-

498-

8706

Fort

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lins

Gen

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Jam

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#38

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ve.,

#110

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970-

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Fort

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DP

#38

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ve.,

#110

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498-

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lins

Gen

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1-2

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Pau

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right

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tal -

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3835

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DP

#17

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Pag

e 11

of 2

4

Page 19: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Bria

n Ta

lley

Com

fort

Den

tal -

Gle

nwoo

d S

prin

gsA

DP

#91

1512

Gra

nd A

ve.

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947-

1273

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nwoo

d Sp

rings

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eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Mic

hael

She

aC

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enta

l - G

lenw

ood

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ings

AD

P #

9115

12 G

rand

Ave

.97

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lenw

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1-2,

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olor

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AD

P #

128

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Tim

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entis

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, E1-

2, E

3-4

Dr.

Mel

issa

J. H

inze

Gen

tle S

mile

s O

f Col

orad

oA

DP

#12

823

05 J

acks

on S

t.30

3-27

8-28

00G

olde

nG

ener

al D

entis

tC

, E1-

2, E

3-4

Dr.

Jess

ica

Kle

inG

entle

Sm

iles

Of C

olor

ado

AD

P #

128

2305

Jac

kson

St.

303-

278-

2800

Gol

den

Gen

eral

Den

tist

C, E

1-2,

E3-

4

Dr.

Sco

tt W

elch

Gol

den

Vie

w D

enta

lA

DP

#21

072

7 S

imm

s S

t., #

e30

3-23

2-36

36G

olde

nG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Nic

hola

s L.

Gro

nem

anC

omfo

rt D

enta

l - G

olde

nA

DP

#90

1753

1 S

. Gol

den

Rd.

303-

278-

6953

Gol

den

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Pau

lette

Diliz

iaC

omfo

rt D

enta

l - G

olde

nA

DP

#90

1753

1 S

. Gol

den

Rd.

303-

278-

6953

Gol

den

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Hea

th C

olle

dge

Com

fort

Den

tal -

Gol

den

AD

P #

9017

531

S. G

olde

n R

d.30

3-27

8-69

53G

olde

nG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Jam

es M

. Tar

rD

r. Ja

mes

M. T

arr

AD

P #

102

2531

W. P

inyo

n A

ve.

970-

242-

5367

Gra

nd J

unct

ion

Gen

eral

Den

tist

C, E

1-2

Dr.

Mat

thew

Hud

son

Hud

son

Fam

ily D

enta

lA

DP

#20

813

2 W

alnu

t Ave

., #-

697

0-24

2-51

51G

rand

Jun

ctio

nG

ener

al D

entis

t*,

C

Dr.

Josh

ua H

ollin

gshe

adC

omfo

rt D

enta

l - G

.J. W

est

AD

P #

252

2502

Hig

hway

6 &

50

#700

970-

241-

2080

Gra

nd J

unct

ion

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Jeffe

ry G

reen

eC

omfo

rt D

enta

l - G

.J. W

est

AD

P #

252

2502

Hig

hway

6 &

50

#700

970-

241-

2080

Gra

nd J

unct

ion

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Jaso

n N

oah

Com

fort

Den

tal -

G.J

. Wes

tA

DP

#25

225

02 H

ighw

ay 6

& 5

0 #7

0097

0-24

1-20

80G

rand

Jun

ctio

nG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

John

A. W

ood`

John

A. W

ood,

DD

SA

DP

#26

910

2 Lo

rey

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e97

0-24

2-49

45G

rand

Jun

ctio

nG

ener

al D

entis

t*,

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C, E

1-2,

E3-

4

Dr.

Sco

tt S

todd

ard

Com

fort

Den

tal-G

rand

Jun

ctio

nA

DP

#61

2650

Nor

th A

ve.

970-

255-

1222

Gra

nd J

unct

ion

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Tyso

n B

lack

Com

fort

Den

tal-G

rand

Jun

ctio

nA

DP

#61

2650

Nor

th A

ve.

970-

255-

1222

Gra

nd J

unct

ion

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Nic

olas

Gan

dola

Com

fort

Den

tal-G

rand

Jun

ctio

nA

DP

#61

2650

Nor

th A

ve.

970-

255-

1222

Gra

nd J

unct

ion

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Jam

es B

radl

eyC

omfo

rt D

enta

l-Gra

nd J

unct

ion

AD

P #

6126

50 N

orth

Ave

.97

0-25

5-12

22G

rand

Jun

ctio

nG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Eric

Ben

efie

ldG

rand

Den

tal

AD

P #

8610

35 G

rand

Ave

.97

0-24

3-85

80G

rand

Jun

ctio

nG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Ste

phen

Bro

wn

Dr.

Ste

phen

Bro

wn

AD

P #

6534

00 W

. 16t

h S

t., B

ldg.

3, S

te. S

970-

356-

8118

Gre

eley

Gen

eral

Den

tist

**, E

1-2

Dr.

Pat

rick

Rin

aldi

sC

omfo

rt D

enta

l - G

reel

eyA

DP

#67

3766

Wes

t 10t

h S

t.97

0-30

4-12

73G

reel

eyG

ener

al D

entis

t**

, C, E

1-2,

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4

Dr.

Cou

rtney

Ste

vens

Com

fort

Den

tal -

Gre

eley

AD

P #

6737

66 W

est 1

0th

St.

970-

304-

1273

Gre

eley

Gen

eral

Den

tist

**, C

, E1-

2, E

3-4

Dr.

And

rey

A. K

ondr

aten

koC

omfo

rt D

enta

l - G

reel

eyA

DP

#67

3766

Wes

t 10t

h S

t.97

0-30

4-12

73G

reel

eyG

ener

al D

entis

t**

, C, E

1-2,

E3-

4

Dr.

Ken

t Day

Sun

rise

Den

tal C

ente

rA

DP

#83

1006

A. S

t.97

0-35

2-00

48G

reel

eyG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Din

orah

Moy

aS

unris

e D

enta

l Cen

ter

AD

P #

8310

06 A

. St.

970-

352-

0048

Gre

eley

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Pag

e 12

of 2

4

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Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Pat

rick

Har

rison

Sun

rise

Den

tal C

ente

rA

DP

#83

1006

A. S

t.97

0-35

2-00

48G

reel

eyG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Shi

vaun

Mca

rtor

Sun

rise

Den

tal C

ente

rA

DP

#83

1006

A. S

t.97

0-35

2-00

48G

reel

eyG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Ale

x K

nech

tS

unris

e D

enta

l Cen

ter

AD

P #

8310

06 A

. St.

970-

352-

0048

Gre

eley

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Mic

hael

Mill

erB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

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ands

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ener

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2, E

3-4,

N

Dr.

Cra

ig A

. Mel

lor

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

ch A

dpA

DP

#93

3626

Hig

hlan

ds R

anch

Pkw

y., #

107

303-

471-

0841

Hig

hlan

ds R

anch

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4, N

Dr.

Mic

hael

Gio

iaB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

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Ran

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kwy.

, #10

730

3-47

1-08

41H

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Ran

chG

ener

al D

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t*,

**,

E1-

2, E

3-4,

N

Dr.

Tiffa

ny F

ritz

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

ch A

dpA

DP

#93

3626

Hig

hlan

ds R

anch

Pkw

y., #

107

303-

471-

0841

Hig

hlan

ds R

anch

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4, N

Dr.

Hyu

nseo

Par

kB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

ighl

ands

Ran

chG

ener

al D

entis

t*,

**,

E1-

2, E

3-4,

N

Dr.

Mire

la G

iurg

iuB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

ighl

ands

Ran

chG

ener

al D

entis

t*,

**,

E1-

2, E

3-4,

N

Dr.

Trac

ie E

. Kel

ler

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

ch A

dpA

DP

#93

3626

Hig

hlan

ds R

anch

Pkw

y., #

107

303-

471-

0841

Hig

hlan

ds R

anch

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4, N

Dr.

Eka

trina

But

kevi

chB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

ighl

ands

Ran

chG

ener

al D

entis

t*,

**,

E1-

2, E

3-4,

N

Dr.

Jam

es A

. Fis

cher

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

ch A

dpA

DP

#93

3626

Hig

hlan

ds R

anch

Pkw

y., #

107

303-

471-

0841

Hig

hlan

ds R

anch

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4, N

Dr.

Sem

iram

ida

Con

doia

nis

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

ch A

dpA

DP

#93

3626

Hig

hlan

ds R

anch

Pkw

y., #

107

303-

471-

0841

Hig

hlan

ds R

anch

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4, N

Dr.

Cur

tis B

roek

erB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

ighl

ands

Ran

chG

ener

al D

entis

t*,

**,

E1-

2, E

3-4,

N

Dr.

Man

isha

Pat

ilB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

ighl

ands

Ran

chG

ener

al D

entis

t*,

**,

E1-

2, E

3-4,

N

Dr.

Mar

k La

wso

nB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

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Ran

ch P

kwy.

, #10

730

3-47

1-08

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ighl

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Ran

chG

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al D

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**,

E1-

2, E

3-4,

N

Dr.

Wam

eedh

A A

bdul

amee

rB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

ighl

ands

Ran

chG

ener

al D

entis

t*,

**,

E1-

2, E

3-4,

N

Dr.

Sym

one

Web

ley

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

ch A

dpA

DP

#93

3626

Hig

hlan

ds R

anch

Pkw

y., #

107

303-

471-

0841

Hig

hlan

ds R

anch

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4, N

Dr.

Cha

rles

Woy

daB

right

Now

Den

tal -

Hig

hlan

ds R

anch

Adp

AD

P #

9336

26 H

ighl

ands

Ran

ch P

kwy.

, #10

730

3-47

1-08

41H

ighl

ands

Ran

chG

ener

al D

entis

t*,

**,

E1-

2, E

3-4,

N

Dr.

Thom

as M

ulhe

ran

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

ch A

dpA

DP

#93

3626

Hig

hlan

ds R

anch

Pkw

y., #

107

303-

471-

0841

Hig

hlan

ds R

anch

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4, N

Dr.

Jaro

m P

aice

Com

fort

Den

tal -

Laf

ayet

teA

DP

#18

753

5 W

. Sou

th B

ould

er R

d., #

200

303-

604-

2804

Lafa

yette

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Mar

c Ya

soni

Com

fort

Den

tal -

Laf

ayet

teA

DP

#18

753

5 W

. Sou

th B

ould

er R

d., #

200

303-

604-

2804

Lafa

yette

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Eva

n K

neal

eC

omfo

rt D

enta

l - L

afay

ette

AD

P #

187

535

W. S

outh

Bou

lder

Rd.

, #20

030

3-60

4-28

04La

faye

tteG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Jack

F. E

mm

ons

95th

Stre

et D

enta

lA

DP

#22

713

73 F

ores

t Par

k C

ircle

, #10

330

3-66

6-77

73La

faye

tteG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Dan

iel G

. Hill

Pro

fess

iona

l Den

tal G

roup

AD

P #

270

1120

W. S

outh

Bou

lder

Roa

d72

0-63

8-21

69La

faye

tteG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Efre

n M

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ezD

r. E

fren

Mar

tinez

AD

P #

130

1200

S. W

adsw

orth

303-

733-

7533

Lake

woo

dG

ener

al D

entis

t**

, E1-

2, E

3-4

Dr.

Jace

Willi

amso

nC

omfo

rt D

enta

l- G

reen

Mou

ntai

nA

DP

#22

012

810

W. A

lam

eda

Ave

.30

3-98

7-22

73La

kew

ood

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Pag

e 13

of 2

4

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Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

And

reea

Tor

okC

omfo

rt D

enta

l- G

reen

Mou

ntai

nA

DP

#22

012

810

W. A

lam

eda

Ave

.30

3-98

7-22

73La

kew

ood

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Jack

son

Ngu

yen

Com

fort

Den

tal-

Gre

en M

ount

ain

AD

P #

220

1281

0 W

. Ala

med

a A

ve.

303-

987-

2273

Lake

woo

dG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Joes

olyn

Cal

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-Kid

dC

omfo

rt D

enta

l- B

ear C

reek

AD

P #

222

3200

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adsw

orth

Blv

d., #

e30

3-71

6-85

46La

kew

ood

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Elo

isa

Lova

toC

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rt D

enta

l- B

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reek

AD

P #

222

3200

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Blv

d., #

e30

3-71

6-85

46La

kew

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Gen

eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Jeffr

ey B

erna

rdy

Com

fort

Den

tal-

Bea

r Cre

ekA

DP

#22

232

00 S

. Wad

swor

th B

lvd.

, #e

303-

716-

8546

Lake

woo

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ener

al D

entis

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C, E

1-2,

E3-

4

Dr.

Khie

m D

uy H

oang

-Xua

nD

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enta

lA

DP

#23

995

C S

. She

ridan

Blv

d.72

0-52

4-39

59La

kew

ood

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Ben

jam

in B

utle

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rt D

enta

l - L

akew

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AD

P #

260

6800

W. A

lam

eda

303-

727-

9100

Lake

woo

dG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Nat

han

Eam

esC

omfo

rt D

enta

l - L

akew

ood

AD

P #

260

6800

W. A

lam

eda

303-

727-

9100

Lake

woo

dG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Pat

Flo

odC

omfo

rt D

enta

l - L

akew

ood

AD

P #

260

6800

W. A

lam

eda

303-

727-

9100

Lake

woo

dG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Col

in B

arto

nC

omfo

rt D

enta

l - L

akew

ood

AD

P #

260

6800

W. A

lam

eda

303-

727-

9100

Lake

woo

dG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Dal

e S

teen

Com

fort

Den

tal -

Lak

ewoo

dA

DP

#26

068

00 W

. Ala

med

a30

3-72

7-91

00La

kew

ood

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Ric

hard

Glu

cksm

anA

lpha

Den

tal X

xA

DP

#3

7373

W. J

effe

rson

, #20

330

3-98

8-15

30La

kew

ood

Gen

eral

Den

tist

*

Dr.

Wam

eedh

A A

bdul

amee

rB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Sym

one

Web

ley

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Dr.

Cha

rles

Woy

daB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Man

isha

Pat

ilB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Thom

as M

ulhe

ran

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Dr.

Sam

path

Vid

hyal

aksh

mi

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Dr.

Dav

id B

ryan

tB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Eka

trina

But

kevi

chB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Mic

hael

Gio

iaB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Lind

sey

Sch

roep

fer

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Dr.

Jeffr

ey P

atric

ian

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Dr.

Mat

thew

You

ngB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Jam

es A

. Fis

cher

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Dr.

Jenn

ifer K

. Lee

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Dr.

Cra

ig A

. Mel

lor

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

C, E

1-2

Pag

e 14

of 2

4

Page 22: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Mire

la G

iurg

iuB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Mic

hael

Mill

erB

right

Now

Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Gilb

ert V

igil

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

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ener

al D

entis

t*,

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Pau

l Pan

tleo

Brig

ht N

ow D

enta

l - L

akew

ood

Adp

AD

P #

9276

11 W

. Col

fax

Ave

., #d

303-

202-

0900

Lake

woo

dG

ener

al D

entis

t*,

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1-2

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Bar

bara

Heu

pel-C

hapm

anB

right

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Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

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kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Leig

h A

. Ste

phen

sB

right

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Den

tal -

Lak

ewoo

d A

dpA

DP

#92

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Gen

eral

Den

tist

*, C

, E1-

2

Dr.

Soni

a G

rew

alH

ighp

lain

s C

omm

unity

Hea

lth C

ente

rA

DP

#54

200

Kend

all D

rive

719-

336-

8445

Lam

arG

ener

al D

entis

t**

, C, E

1-2

Dr.

Sal

vado

r Ram

irez

Hig

hpla

ins

Com

mun

ity H

ealth

Cen

ter

AD

P #

5420

0 Ke

ndal

l Driv

e71

9-33

6-84

45La

mar

Gen

eral

Den

tist

**, C

, E1-

2

Dr.

Ang

ela

Nag

elH

ighp

lain

s C

omm

unity

Hea

lth C

ente

rA

DP

#54

200

Kend

all D

rive

719-

336-

8445

Lam

arG

ener

al D

entis

t**

, C, E

1-2

Dr.

Ric

hard

Phi

llips

Hig

hpla

ins

Com

mun

ity H

ealth

Cen

ter

AD

P #

5420

0 Ke

ndal

l Driv

e71

9-33

6-84

45La

mar

Gen

eral

Den

tist

**, C

, E1-

2

Dr.

Kyl

e R

Lam

bert

Lasa

lle F

amily

Den

tistry

AD

P #

2320

2 2n

d S

t.97

0-28

4-77

30La

salle

Gen

eral

Den

tist

**, C

Dr.

Ric

hard

J. B

irkel

Com

fort

Den

tal-

Littl

eton

Blv

d.A

DP

#13

220

9-B

W. L

ittle

ton

Blv

d.30

3-73

4-22

73Li

ttlet

onG

ener

al D

entis

t*,

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C, E

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4, N

Dr.

Jeffr

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pieg

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rt D

enta

l- Li

ttlet

on B

lvd.

AD

P #

132

209-

B W

. Litt

leto

n B

lvd.

303-

734-

2273

Littl

eton

Gen

eral

Den

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, E1-

2, E

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N

Dr.

Bru

ce H

. Joh

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Bru

ce H

. Joh

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AD

P #

140

7641

Sha

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kwy

303-

989-

0577

Littl

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Gen

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Dav

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enta

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ton

AD

P #

182

8420

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ine

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Dr.

Thom

as K

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enta

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ittle

ton

AD

P #

182

8420

W. C

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ine

Ave

.30

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73Li

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Dr.

Bill

Old

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awC

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enta

l - L

ittle

ton

AD

P #

182

8420

W. C

oal M

ine

Ave

.30

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73Li

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ener

al D

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4

Dr.

Bra

d W

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rt D

enta

l - L

ittle

ton

AD

P #

182

8420

W. C

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ine

Ave

.30

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73Li

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4

Dr.

Kat

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Roj

ohn

Com

fort

Den

tal-

Bel

levi

ew &

Sim

ms

AD

P #

217

1162

5 W

. Bel

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4

Dr.

Tam

Tha

nC

omfo

rt D

enta

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elle

view

& S

imm

sA

DP

#21

711

625

W. B

elle

view

303-

972-

8700

Littl

eton

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Jaso

n H

eint

zC

omfo

rt D

enta

l- B

elle

view

& S

imm

sA

DP

#21

711

625

W. B

elle

view

303-

972-

8700

Littl

eton

Gen

eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Nan

cy C

ashm

anS

outh

wes

t Adu

lt D

entis

tryA

DP

#27

369

31 S

. Pie

rce

St.

720-

974-

2500

Littl

eton

Gen

eral

Den

tist

*, *

*, E

1-2,

E3-

4

Dr.

Mat

thew

Ste

vens

Com

fort

Den

tal -

Hig

hlan

ds R

anch

AD

P #

4091

W. M

iner

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ve. #

150

303-

738-

9499

Littl

eton

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Nin

a G

omen

yuk

Com

fort

Den

tal -

Hig

hlan

ds R

anch

AD

P #

4091

W. M

iner

al A

ve. #

150

303-

738-

9499

Littl

eton

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Mic

hael

Lov

eC

omfo

rt D

enta

l - H

ighl

ands

Ran

chA

DP

#40

91 W

. Min

eral

Ave

. #15

030

3-73

8-94

99Li

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onG

ener

al D

entis

t*,

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C, E

1-2,

E3-

4

Dr.

Willi

am D

Mcr

eyno

lds

Com

fort

Den

tal -

Hig

hlan

ds R

anch

AD

P #

4091

W. M

iner

al A

ve. #

150

303-

738-

9499

Littl

eton

Gen

eral

Den

tist

*, *

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, E1-

2, E

3-4

Dr.

Elli

as N

ajja

rB

elle

view

Den

tal A

ssoc

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sA

DP

#69

1018

4 W

. Bel

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t*

Pag

e 15

of 2

4

Page 23: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Mar

gare

ta P

avel

Dut

ch C

reek

Den

tal

AD

P #

7883

70 W

. Coa

l Min

e A

ve.,

#103

303-

978-

1522

Littl

eton

Gen

eral

Den

tist

*, C

, E1-

2, E

3-4

Dr.

Eric

Wal

ker

Cla

ssic

Den

tal,

Ltd.

AD

P #

230

1004

7 P

ark

Mea

dow

s D

r., #

b30

3-76

8-88

48Lo

ne T

ree

Gen

eral

Den

tist

**, C

, E1-

2, E

3-4

Dr.

Con

rad

Stu

tzne

gger

Com

fort

Den

tal -

Lon

gmon

tA

DP

#15

617

50 M

ount

ain

Vie

w30

3-67

8-77

83Lo

ngm

ont

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Aaro

n D

. Mor

tens

enC

omfo

rt D

enta

l - L

ongm

ont

AD

P #

156

1750

Mou

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303-

678-

7783

Long

mon

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4

Dr.

Ste

phen

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wel

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omfo

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enta

l - L

ongm

ont

AD

P #

156

1750

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303-

678-

7783

Long

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1-2,

E3-

4

Dr.

Jolly

Joh

nson

Com

fort

Den

tal -

Lon

gmon

tA

DP

#15

617

50 M

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w30

3-67

8-77

83Lo

ngm

ont

Gen

eral

Den

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*, *

*, C

, E1-

2, E

3-4

Dr.

Cra

ig G

. Lar

son

Lars

on F

amily

Den

tistry

AD

P #

242

2051

Ter

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303-

678-

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E3-

4

Dr.

Jack

F. E

mm

ons

Brig

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enta

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dpA

DP

#59

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d., #

280

303-

678-

1155

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Dr.

Yehi

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Brig

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enta

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dpA

DP

#59

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280

303-

678-

1155

Long

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Dr.

Cra

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lor

Brig

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enta

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DP

#59

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d., #

280

303-

678-

1155

Long

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4

Dr.

Jam

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. Fis

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Brig

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DP

#59

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280

303-

678-

1155

Long

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Dr.

Geo

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Dilb

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Brig

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DP

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280

303-

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1155

Long

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Julio

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Brig

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DP

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280

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1155

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tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Jeffr

ey P

atric

ian

Brig

ht N

ow D

enta

l - L

ongm

ont A

dpA

DP

#59

15 K

en P

ratt

Blv

d., #

280

303-

678-

1155

Long

mon

tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Mar

iano

De

La R

iva

Brig

ht N

ow D

enta

l - L

ongm

ont A

dpA

DP

#59

15 K

en P

ratt

Blv

d., #

280

303-

678-

1155

Long

mon

tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Bra

ndon

Mur

riB

right

Now

Den

tal -

Lon

gmon

t Adp

AD

P #

5915

Ken

Pra

tt B

lvd.

, #28

030

3-67

8-11

55Lo

ngm

ont

Gen

eral

Den

tist

*, C

, E1-

2, E

3-4

Dr.

Thom

as M

ulhe

ran

Brig

ht N

ow D

enta

l - L

ongm

ont A

dpA

DP

#59

15 K

en P

ratt

Blv

d., #

280

303-

678-

1155

Long

mon

tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Dav

id R

. Mak

iB

right

Now

Den

tal -

Lon

gmon

t Adp

AD

P #

5915

Ken

Pra

tt B

lvd.

, #28

030

3-67

8-11

55Lo

ngm

ont

Gen

eral

Den

tist

*, C

, E1-

2, E

3-4

Dr.

Dav

id B

ryan

tB

right

Now

Den

tal -

Lon

gmon

t Adp

AD

P #

5915

Ken

Pra

tt B

lvd.

, #28

030

3-67

8-11

55Lo

ngm

ont

Gen

eral

Den

tist

*, C

, E1-

2, E

3-4

Dr.

Chr

isto

pher

C F

riedl

Brig

ht N

ow D

enta

l - L

ongm

ont A

dpA

DP

#59

15 K

en P

ratt

Blv

d., #

280

303-

678-

1155

Long

mon

tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Hea

th C

olle

dge

Com

fort

Den

tal -

Lou

isvi

lleA

DP

#17

339

Mcc

aslin

Blv

d., #

b30

3-67

3-05

00Lo

uisv

ille

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Rya

n T

Lear

yC

omfo

rt D

enta

l - L

ouis

ville

AD

P #

1733

9 M

ccas

lin B

lvd.

, #b

303-

673-

0500

Loui

svill

eG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Eric

B B

ouch

erC

omfo

rt D

enta

l - L

ouis

ville

AD

P #

1733

9 M

ccas

lin B

lvd.

, #b

303-

673-

0500

Loui

svill

eG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Nic

hola

s L.

Gro

nem

anC

omfo

rt D

enta

l - L

ouis

ville

AD

P #

1733

9 M

ccas

lin B

lvd.

, #b

303-

673-

0500

Loui

svill

eG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Joan

ne L

Ban

crof

tB

right

Now

Den

tal -

Lov

elan

dA

DP

#14

614

40 W

. 29t

h S

t., #

400

970-

622-

0922

Love

land

Gen

eral

Den

tist

**, E

1-2

Dr.

Jack

F. E

mm

ons

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Mar

iano

De

La R

iva

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Pag

e 16

of 2

4

Page 24: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Yehi

a E

lgoh

ary

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Cra

ig A

. Mel

lor

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Geo

ffery

Dilb

ert

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Eth

elyn

G T

hom

ason

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Jeffr

ey P

atric

ian

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Chr

isto

pher

C F

riedl

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Eka

trina

But

kevi

chB

right

Now

Den

tal -

Lov

elan

dA

DP

#14

614

40 W

. 29t

h S

t., #

400

970-

622-

0922

Love

land

Gen

eral

Den

tist

**, E

1-2

Dr.

Dav

id B

ryan

tB

right

Now

Den

tal -

Lov

elan

dA

DP

#14

614

40 W

. 29t

h S

t., #

400

970-

622-

0922

Love

land

Gen

eral

Den

tist

**, E

1-2

Dr.

Thom

as M

ulhe

ran

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Dr.

Jam

es A

. Fis

cher

Brig

ht N

ow D

enta

l - L

ovel

and

AD

P #

146

1440

W. 2

9th

St.,

#40

097

0-62

2-09

22Lo

vela

ndG

ener

al D

entis

t**

, E1-

2

Pag

e 17

of 2

4

Page 25: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Gre

gory

S. W

insl

owC

omfo

rt D

enta

l- N

orth

Lov

elan

dA

DP

#19

327

4 W

. 64t

h S

t.97

0-66

7-04

46Lo

vela

ndG

ener

al D

entis

t**

, C, E

1-2,

E3-

4

Dr.

Mik

al L

indm

anC

omfo

rt D

enta

l- N

orth

Lov

elan

dA

DP

#19

327

4 W

. 64t

h S

t.97

0-66

7-04

46Lo

vela

ndG

ener

al D

entis

t**

, C, E

1-2,

E3-

4

Dr.

Jeffe

ry B

ourn

eC

omfo

rt D

enta

l- N

orth

Lov

elan

dA

DP

#19

327

4 W

. 64t

h S

t.97

0-66

7-04

46Lo

vela

ndG

ener

al D

entis

t**

, C, E

1-2,

E3-

4

Dr.

Pat

rick

Har

rison

Love

land

Com

mun

ity H

ealth

Cen

ter

AD

P #

8745

0 N

. Cle

vela

nd A

ve.

970-

461-

8942

Love

land

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Vic

toria

L. D

riski

llC

omfo

rt D

enta

l-Mon

umen

tA

DP

#14

255

6 W

. Hig

hway

105

719-

484-

0043

Mon

umen

tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Mic

hael

Gio

iaC

omfo

rt D

enta

l-Mon

umen

tA

DP

#14

255

6 W

. Hig

hway

105

719-

484-

0043

Mon

umen

tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Ste

ve C

arte

rC

omfo

rt D

enta

l-Mon

umen

tA

DP

#14

255

6 W

. Hig

hway

105

719-

484-

0043

Mon

umen

tG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Chr

isto

pher

Has

selb

ack

Com

fort

Den

tal-M

onum

ent

AD

P #

142

556

W. H

ighw

ay 1

0571

9-48

4-00

43M

onum

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Gen

eral

Den

tist

*, C

, E1-

2, E

3-4

Dr.

Ste

war

t Mos

sS

tuar

t Mos

s &

Ass

ocia

tes

AD

P #

442

1 W

. 104

th A

ve.,

#201

303-

427-

6462

Nor

thgl

enn

Gen

eral

Den

tist

*, *

*, E

1-2,

N

Dr.

Ron

ald

J. F

reim

uth

Com

fort

Den

tal -

Par

ker

AD

P #

111

1287

0 S

troh

Ran

ch C

ourt

303-

840-

6543

Park

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ener

al D

entis

t*,

C, E

1-2,

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4, N

Dr.

Sco

tt H

ende

rson

Com

fort

Den

tal -

Par

ker

AD

P #

111

1287

0 S

troh

Ran

ch C

ourt

303-

840-

6543

Park

erG

ener

al D

entis

t*,

C, E

1-2,

E3-

4, N

Dr.

Nat

hani

el M

. She

rman

Com

fort

Den

tal -

Par

ker

AD

P #

111

1287

0 S

troh

Ran

ch C

ourt

303-

840-

6543

Park

erG

ener

al D

entis

t*,

C, E

1-2,

E3-

4, N

Dr.

Mic

hael

A. H

olm

Com

fort

Den

tal -

Par

ker

AD

P #

111

1287

0 S

troh

Ran

ch C

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303-

840-

6543

Park

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ener

al D

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C, E

1-2,

E3-

4, N

Dr.

Mic

hael

Mill

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xfie

ld D

enta

lA

DP

#20

716

350

E. A

rapa

hoe

Rd.

, #-1

1472

0-87

0-04

01Pa

rker

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Pau

l Pan

tleo

Brig

ht N

ow D

enta

l - P

arke

r Adp

AD

P #

234

1118

3 S

. Par

ker R

d., #

c30

3-20

9-22

45Pa

rker

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Eth

elyn

G T

hom

ason

Brig

ht N

ow D

enta

l - P

arke

r Adp

AD

P #

234

1118

3 S

. Par

ker R

d., #

c30

3-20

9-22

45Pa

rker

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Mar

k La

wso

nB

right

Now

Den

tal -

Par

ker A

dpA

DP

#23

411

183

S. P

arke

r Rd.

, #c

303-

209-

2245

Park

erG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Sam

path

Vid

hyal

aksh

mi

Brig

ht N

ow D

enta

l - P

arke

r Adp

AD

P #

234

1118

3 S

. Par

ker R

d., #

c30

3-20

9-22

45Pa

rker

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Cra

ig A

. Mel

lor

Brig

ht N

ow D

enta

l - P

arke

r Adp

AD

P #

234

1118

3 S

. Par

ker R

d., #

c30

3-20

9-22

45Pa

rker

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Sym

one

Web

ley

Brig

ht N

ow D

enta

l - P

arke

r Adp

AD

P #

234

1118

3 S

. Par

ker R

d., #

c30

3-20

9-22

45Pa

rker

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Dan

iel L

arsc

heid

Flos

s D

enta

lA

DP

#25

510

233

S. P

arke

r Rd.

#20

330

3-92

7-05

62Pa

rker

Gen

eral

Den

tist

*, C

, E1-

2, E

3-4

Dr.

Mic

hael

G. H

ale

Dr.

Mic

hael

G. H

ale

AD

P #

2719

751

E. M

ains

treet

, #r1

630

3-84

1-33

22Pa

rker

Gen

eral

Den

tist

C, N

Dr.

Joel

Sta

fford

Com

fort

Den

tal-F

alco

n H

illsA

DP

#12

711

605

Mer

idia

n M

arke

t Vie

w, #

154

719-

495-

8989

Peyt

onG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Jona

than

Har

vey

Com

fort

Den

tal-F

alco

n H

illsA

DP

#12

711

605

Mer

idia

n M

arke

t Vie

w, #

154

719-

495-

8989

Peyt

onG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Cha

d J.

Mur

dock

Com

fort

Den

tal-F

alco

n H

illsA

DP

#12

711

605

Mer

idia

n M

arke

t Vie

w, #

154

719-

495-

8989

Peyt

onG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Anth

ony

Know

lton

Dr.

Ant

hony

Kno

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DP

#42

3939

San

dalw

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Lane

719-

564-

5833

Pueb

loG

ener

al D

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t*,

C, E

1-2,

E3-

4, N

Dr.

Ric

hard

C. M

ores

chin

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rd C

. Mor

esch

ini

AD

P #

5210

00 W

. 6th

St.

719-

542-

7420

Pueb

loG

ener

al D

entis

tC

, E1-

2, N

Pag

e 18

of 2

4

Page 26: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Phi

llip H

olde

nC

omfo

rt D

enta

l - P

uebl

o - N

orth

AD

P #

6320

25 W

. Us

Hw

y. 5

0, #

a 10

071

9-54

2-24

72Pu

eblo

Gen

eral

Den

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*, *

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, E1-

2, E

3-4

Dr.

Karle

en L

. Tre

filC

omfo

rt D

enta

l - P

uebl

o - N

orth

AD

P #

6320

25 W

. Us

Hw

y. 5

0, #

a 10

071

9-54

2-24

72Pu

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Gen

eral

Den

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*, *

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, E1-

2, E

3-4

Dr.

Eld

en M

. Ric

eC

omfo

rt D

enta

l - P

uebl

o - N

orth

AD

P #

6320

25 W

. Us

Hw

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0, #

a 10

071

9-54

2-24

72Pu

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Gen

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Den

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, E1-

2, E

3-4

Dr.

Bra

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. Sm

ithC

omfo

rt D

enta

l - P

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o - N

orth

AD

P #

6320

25 W

. Us

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071

9-54

2-24

72Pu

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Gen

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Den

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*, *

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, E1-

2, E

3-4

Dr.

Ste

ven

P. R

ose

Com

fort

Den

tal -

Pue

blo

- Sou

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dpA

DP

#80

1221

S. P

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o B

lvd.

719-

565-

2274

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4

Dr.

Bra

dley

Mic

hael

Alm

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Com

fort

Den

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blo

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dpA

DP

#80

1221

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719-

565-

2274

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ener

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AD

P #

8012

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. Pue

blo

Blv

d.71

9-56

5-22

74Pu

eblo

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Jeffe

ry A

. Moe

ller

Com

fort

Den

tal -

Pue

blo

- Sou

th A

dpA

DP

#80

1221

S. P

uebl

o B

lvd.

719-

565-

2274

Pueb

loG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Gin

o O

rtego

nD

r. G

ino

Orte

gon

AD

P #

8540

1 W

.12t

h S

t.71

9-58

3-05

55Pu

eblo

Gen

eral

Den

tist

**, C

, E1-

2, N

Dr.

Gar

y G

rave

sD

r. G

ary

Gra

ves

AD

P #

9913

45 S

. Pue

blo

Blv

d.71

9-54

2-35

95Pu

eblo

Gen

eral

Den

tist

*, *

*, C

, E1-

2

Dr.

Lorra

ine

Mun

dyC

omfo

rt D

enta

l- S

umm

it C

ount

y A

dpA

DP

#64

354

Blu

e R

iver

Pkw

y, #

a97

0-26

2-22

73Si

lver

thor

neG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

John

Rol

low

, Iv

Com

fort

Den

tal-

Sum

mit

Cou

nty

Adp

AD

P #

6435

4 B

lue

Riv

er P

kwy,

#a

970-

262-

2273

Silv

erth

orne

Gen

eral

Den

tist

*, C

, E1-

2, E

3-4

Dr.

Ran

dall

C. J

ones

Ran

dall

C. J

ones

AD

P #

1514

02 S

. 3rd

Ave

.97

0-52

2-62

80St

erlin

gG

ener

al D

entis

t*,

C, E

1-2,

E3-

4

Dr.

Lind

sey

Sch

roep

fer

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Luan

K. T

ran

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Julio

Sek

ler

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Thom

as M

ulhe

ran

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Gilb

ert V

igil

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Kris

tin L

ere

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Chr

isto

pher

C F

riedl

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Eth

elyn

G T

hom

ason

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Ase

el D

Has

anB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Bra

ndon

Mur

riB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Jack

F. E

mm

ons

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Pag

e 19

of 2

4

Page 27: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Geo

ffery

Dilb

ert

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Sam

path

Vid

hyal

aksh

mi

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Leig

h A

. Ste

phen

sB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Hyu

nseo

Par

kB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Eka

trina

But

kevi

chB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Mar

iano

De

La R

iva

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Mat

thew

You

ngB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Bar

bara

Heu

pel-C

hapm

anB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Yehi

a E

lgoh

ary

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Trav

is W

illey

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Jam

es A

. Fis

cher

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Joan

ne L

Ban

crof

tB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Cra

ig A

. Mel

lor

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Jeffr

ey P

atric

ian

Brig

ht N

ow D

enta

l - W

estm

inst

er A

dpA

DP

#12

130

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erG

ener

al D

entis

tC

, E1-

2

Dr.

Dav

id B

ryan

tB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Wam

eedh

A A

bdul

amee

rB

right

Now

Den

tal -

Wes

tmin

ster

Adp

AD

P #

121

3003

W. 1

04th

Ave

nue

303-

410-

9800

Wes

tmin

ster

Gen

eral

Den

tist

C, E

1-2

Dr.

Con

stan

za C

ubillo

sC

omfo

rt D

enta

l-80t

h &

She

ridan

AD

P #

223

7990

N. S

herid

an B

lvd.

303-

650-

4101

Wes

tmin

ster

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Rya

n M

angr

umC

omfo

rt D

enta

l-80t

h &

She

ridan

AD

P #

223

7990

N. S

herid

an B

lvd.

303-

650-

4101

Wes

tmin

ster

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Ian

Ferg

uson

Com

fort

Den

tal-8

0th

& S

herid

anA

DP

#22

379

90 N

. She

ridan

Blv

d.30

3-65

0-41

01W

estm

inst

erG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Sar

a M

arch

bank

sC

omfo

rt D

enta

l - W

heat

Rid

geA

DP

#15

399

90 W

. 26t

h A

ve, #

100

303-

232-

4500

Whe

at R

idge

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Chr

isto

pher

Has

selb

ack

Com

fort

Den

tal -

Whe

at R

idge

AD

P #

153

9990

W. 2

6th

Ave

, #10

030

3-23

2-45

00W

heat

Rid

geG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Lew

is S

herm

anC

omfo

rt D

enta

l - W

heat

Rid

geA

DP

#15

399

90 W

. 26t

h A

ve, #

100

303-

232-

4500

Whe

at R

idge

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Willi

am M

cgla

shan

Com

fort

Den

tal -

Whe

at R

idge

AD

P #

153

9990

W. 2

6th

Ave

, #10

030

3-23

2-45

00W

heat

Rid

geG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Jose

ph S

toll

Jose

ph S

toll

AD

P #

253

7015

W 3

8th

Ave

303-

940-

9755

Whe

at R

idge

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Kel

van

C L

uff

Bel

-Aire

Den

tal P

artn

ers

AD

P #

261

3815

N. W

adsw

orth

Blv

d.72

0-53

6-04

00W

heat

Rid

geG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Dr.

Ste

phen

Spe

ncer

Bel

-Aire

Den

tal P

artn

ers

AD

P #

261

3815

N. W

adsw

orth

Blv

d.72

0-53

6-04

00W

heat

Rid

geG

ener

al D

entis

t*,

**,

C, E

1-2,

E3-

4

Pag

e 20

of 2

4

Page 28: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Trav

is K

Rus

tB

el-A

ire D

enta

l Par

tner

sA

DP

#26

138

15 N

. Wad

swor

th B

lvd.

720-

536-

0400

Whe

at R

idge

Gen

eral

Den

tist

*, *

*, C

, E1-

2, E

3-4

Dr.

Mel

issa

J. H

inze

Gen

tle S

mile

s O

f Col

orad

oA

DP

#26

788

50 W

. 38t

h Av

e. S

uite

D30

3-42

5-51

00W

heat

Rid

geG

ener

al D

entis

tC

, E1-

2, E

3-4

Dr.

Tim

othy

Wac

huta

Gen

tle S

mile

s O

f Col

orad

oA

DP

#26

788

50 W

. 38t

h Av

e. S

uite

D30

3-42

5-51

00W

heat

Rid

geG

ener

al D

entis

tC

, E1-

2, E

3-4

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - A

rvad

aN

ot N

eede

d79

85 W

adsw

orth

Blv

d., #

b30

3-20

9-22

50A

rvad

aO

rthod

ontis

tN

/A

Dr.

Jam

es H

. Mas

onC

olo

Orth

odon

tics

Not

Nee

ded

6390

Gar

deni

a S

t., #

200

303-

421-

2616

Arv

ada

Orth

odon

tist

N/A

Dr.

Gal

en L

. Cal

lend

erG

alen

L. C

alle

nder

Not

Nee

ded

7207

Gra

ndvi

ew A

ve.

303-

421-

1984

Arv

ada

Orth

odon

tist

N/A

Dr.

Hila

ry N

eilb

erg-

Bas

kin

All

Abou

t Bra

ces

Not

Nee

ded

1515

9 E.

Col

fax

Ave.

#b

303-

476-

6233

Aur

ora

Orth

odon

tist

N/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - A

uror

a - S

. Tow

er R

d.N

ot N

eede

d35

51 S

. Tow

er R

d., #

c30

3-40

0-36

69A

uror

aO

rthod

ontis

tN

/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - S

mok

y H

illN

ot N

eede

d23

963

Pro

spec

t Ave

, #e

303-

400-

9898

Aur

ora

Orth

odon

tist

N/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - S

mok

y H

illN

ot N

eede

d23

963

Pro

spec

t Ave

, #e

303-

400-

9898

Aur

ora

Orth

odon

tist

N/A

Dr.

Jam

es H

. Mas

onC

olo

Orth

odon

tics

Not

Nee

ded

2993

S. P

eoria

St.,

#26

030

3-75

1-57

00A

uror

aO

rthod

ontis

tN

/A

Dr.

John

Bai

ley

Col

o O

rthod

ontic

sN

ot N

eede

d29

93 S

. Peo

ria S

t., #

260

303-

751-

5700

Aur

ora

Orth

odon

tist

N/A

Dr.

Ran

dall

Sny

der

Com

fort

Den

tal -

Hav

ana

Not

Nee

ded

1040

1 E.

Col

fax

Ave.

, #15

030

3-34

4-22

73A

uror

aO

rthod

ontis

tN

/A

Dr.

Jack

E. D

uran

Dr.

Jack

E. D

uran

Not

Nee

ded

1370

1 E

. Mis

siss

ippi

Ave

., #

360

303-

789-

9257

Aur

ora

Orth

odon

tist

N/A

Dr.

Jenn

ifer B

erw

ick

Ohm

art O

rthod

ontic

sN

ot N

eede

d25

521

E. S

mok

y H

ill R

oad,

#20

030

3-58

6-57

50A

uror

aO

rthod

ontis

tN

/A

Dr.

Roy

M. L

oren

zR

oy M

. Lor

enz,

DM

D, M

SN

ot N

eede

d14

991

E. H

ampd

en A

ve.,

#320

303-

690-

2333

Aur

ora

Orth

odon

tist

N/A

Dr.

John

Wal

ker

Dr.

John

Wal

ker

Not

Nee

ded

350

Bro

adw

ay, #

120

303-

494-

3535

Bou

lder

Orth

odon

tist

N/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - C

astle

Roc

kN

ot N

eede

d18

8 Fo

unde

rs P

arkw

ay, U

nit A

303-

668-

0252

Cas

tle R

ock

Orth

odon

tist

N/A

Dr.

Ran

dall

Sny

der

Com

fort

Kid

s S

outh

Not

Nee

ded

4121

E. C

ount

y Li

ne R

oad

720-

277-

5930

Cen

tenn

ial

Orth

odon

tist

N/A

Dr.

Dav

id E

. Gol

dD

avid

E. G

old

Jr.

Not

Nee

ded

9025

E. M

iner

al C

ir., #

100

303-

792-

0345

Cen

tenn

ial

Orth

odon

tist

N/A

Dr.

Loui

s Ta

lmou

mis

App

le O

rthod

ontic

sN

ot N

eede

d16

94 E

. Che

yenn

e M

tn. B

lvd.

719-

538-

4671

Col

orad

o Sp

rings

Orth

odon

tist

N/A

Dr.

Dav

id S

chro

eder

App

le O

rthod

ontic

sN

ot N

eede

d16

94 E

. Che

yenn

e M

tn. B

lvd.

719-

538-

4671

Col

orad

o Sp

rings

Orth

odon

tist

N/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - C

olor

ado

Spr

ings

- P

arkm

oor V

illage

Not

Nee

ded

3208

N. A

cade

my

Blv

d., #

140

719-

596-

7000

Col

orad

o Sp

rings

Orth

odon

tist

N/A

Dr.

Ran

dall

Sny

der

Com

fort

Den

tal -

Aus

tin B

luffs

Not

Nee

ded

3952

Nor

th A

cade

my

Blv

d.71

9-59

1-18

11C

olor

ado

Sprin

gsO

rthod

ontis

tN

/A

Dr.

Sco

tt S

uter

Fron

t Ran

ge O

rtho

Not

Nee

ded

3100

N. A

cade

my

Blv

d., #

200

719-

550-

0222

Col

orad

o Sp

rings

Orth

odon

tist

N/A

Ort

hodo

ntis

ts

Pag

e 21

of 2

4

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Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Voyt

ek B

obak

Dr.

Voy

tek

Bob

akN

ot N

eede

d26

697

Ple

asan

t Par

k R

d., #

b-12

030

3-81

6-52

39C

onife

rO

rthod

ontis

tN

/A

Dr.

Hila

ry N

eilb

erg-

Bas

kin

All

Abo

ut B

race

sN

ot N

eede

d22

50 S

. Mon

aco

Pkw

y.30

3-47

6-62

33D

enve

rO

rthod

ontis

tN

/A

Dr.

Andr

ey N

azar

ovA

llegr

o O

rthod

ontic

sN

ot N

eede

d39

0 S

. Day

ton

St.

303-

751-

0031

Den

ver

Orth

odon

tist

N/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - D

enve

r Dow

ntow

nN

ot N

eede

d19

55 A

rapa

hoe

St.,

Ste

. A30

3-29

6-08

88D

enve

rO

rthod

ontis

tN

/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - D

enve

r Dow

ntow

nN

ot N

eede

d19

55 A

rapa

hoe

St.,

Ste

. A30

3-29

6-08

88D

enve

rO

rthod

ontis

tN

/A

Dr.

Mic

hael

D. B

ello

nD

r. M

icha

el D

. Bel

lon

Not

Nee

ded

7200

E. H

ampd

en, #

203

303-

692-

9610

Den

ver

Orth

odon

tist

N/A

Dr.

Eun

ice

P. L

eeH

ampd

en F

amily

Den

tistry

$ O

rthod

ontic

sN

ot N

eede

d92

50 E

. Ham

pden

Ave

.30

3-93

0-88

28D

enve

rO

rthod

ontis

tN

/A

Dr.

Jack

E. D

uran

Orth

odon

tics

Exl

usiv

ely

Not

Nee

ded

3601

S. C

lark

son

303-

789-

9257

Engl

ewoo

dO

rthod

ontis

tN

/A

Dr.

Hila

ry N

eilb

erg-

Bas

kin

All

Abo

ut B

race

sN

ot N

eede

d10

15 S

. Taf

t Hills

Rd.

#q

303-

476-

6233

Fort

Col

lins

Orth

odon

tist

N/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - F

ort C

ollin

sN

ot N

eede

d35

31 S

. Col

lege

Ave

., #1

1097

0-49

8-87

06Fo

rt C

ollin

sO

rthod

ontis

tN

/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - F

ort C

ollin

sN

ot N

eede

d35

31 S

. Col

lege

Ave

., #1

1097

0-49

8-87

06Fo

rt C

ollin

sO

rthod

ontis

tN

/A

Dr.

Tim

othy

C. H

ardy

Taft

Hill

Orth

odon

tics

Not

Nee

ded

1015

Sou

th T

aft H

ill R

d. U

nit 2

970-

980-

2145

Fort

Col

lins

Orth

odon

tist

N/A

Dr.

T. A

llan

Hym

asM

esa

Orth

odon

tics

Not

Nee

ded

1190

Boo

kclif

f, A

ve.,

Ste

. 202

970-

245-

8810

Gra

nd J

unct

ion

Orth

odon

tist

N/A

Dr.

Gar

y B

arth

Dr.

Gar

y B

arth

Not

Nee

ded

1640

25t

h S

t., #

a97

0-35

3-42

49G

reel

eyO

rthod

ontis

tN

/A

Dr.

Sha

wn

Mur

ray

Mur

ry O

rthod

ontic

s O

f Gre

eley

Not

Nee

ded

1825

56t

h A

ve.,

#a97

0-33

0-53

63G

reel

eyO

rthod

ontis

tN

/A

Dr.

Dav

id R

icht

erR

icht

er O

rthod

ontic

sN

ot N

eede

d18

13 6

1st A

ve.

970-

392-

1733

Gre

eley

Orth

odon

tist

N/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

chN

ot N

eede

d36

26 H

ighl

ands

Ran

ch P

kwy,

#10

797

0-49

8-87

06H

ighl

ands

Ran

chO

rthod

ontis

tN

/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - H

ighl

ands

Ran

chN

ot N

eede

d36

26 H

ighl

ands

Ran

ch P

kwy,

#10

797

0-49

8-87

06H

ighl

ands

Ran

chO

rthod

ontis

tN

/A

Dr.

Pau

l A. H

amer

sky

Dou

glas

Cou

nty

Orth

odon

tics

Not

Nee

ded

9362

S. C

olor

ado

Blvd

., #d

1472

0-34

4-26

62H

ighl

ands

Ran

chO

rthod

ontis

tN

/A

Dr.

Bry

an N

elso

nD

r. B

ryan

Nel

son

Not

Nee

ded

9567

S.U

nive

rsity

Blv

d., #

c-1a

720-

344-

2662

Hig

hlan

ds R

anch

Orth

odon

tist

N/A

Dr.

Pau

l Roc

keD

r. P

aul R

ocke

Not

Nee

ded

200

W. C

ount

y Li

ne R

d., #

340

303-

730-

7002

Hig

hlan

ds R

anch

Orth

odon

tist

N/A

Dr.

Sha

wn

M. M

urra

yM

urra

y O

rthod

ontic

sN

ot N

eede

d25

7 Jo

hnst

own

Cen

ter D

r., #

201

970-

587-

5228

John

stow

nO

rthod

ontis

tN

/A

Dr.

How

ard

Stri

nger

tD

r. H

owar

d S

tring

ert

Not

Nee

ded

313

W. 3

rd S

t., #

104

719-

384-

5583

La J

unta

Orth

odon

tist

N/A

Dr.

Hila

ry N

eilb

erg-

Bas

kin

All

Abo

ut B

race

sN

ot N

eede

d20

20 W

adsw

orth

Blv

d.30

3-47

6-62

33La

kew

ood

Orth

odon

tist

N/A

Dr.

Ant

onio

Silv

a-O

segu

era

Ant

onio

Silv

a-O

segu

era

Not

Nee

ded

1200

S. W

adsw

orth

Blv

d. #

101

303-

934-

4285

Lake

woo

dO

rthod

ontis

tN

/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - L

akew

ood

Not

Nee

ded

7611

W. C

olfa

x A

ve.,

#d30

3-20

2-09

00La

kew

ood

Orth

odon

tist

N/A

Pag

e 22

of 2

4

Page 30: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Jack

Alle

n Jr

.D

r. Ja

ck M

. Alle

n D

.D.S

.N

ot N

eede

d73

73 W

. Jef

fers

on A

ve.,

#302

303-

988-

9220

Lake

woo

dO

rthod

ontis

tN

/A

Dr.

Voyt

ek B

obak

Dr.

Voy

tek

Bob

akN

ot N

eede

d18

40 S

. Wad

swor

th B

lvd.

303-

988-

0844

Lake

woo

dO

rthod

ontis

tN

/A

Dr.

Mic

hael

D. B

ello

nD

r. M

icha

el D

. Bel

lon

Not

Nee

ded

7325

S. P

ierc

e S

t., #

204

303-

933-

6830

Littl

eton

Orth

odon

tist

N/A

Dr.

Pau

l Roc

keFr

ont R

ange

Orth

odon

ticN

ot N

eede

d20

0 W

est C

ount

y Li

ne R

d., #

340

303-

730-

7002

Littl

eton

Orth

odon

tist

N/A

Dr.

Amir

R. F

erey

doun

iK

ids

And

Fam

ily D

entis

tryN

ot N

eede

d40

W. L

ittle

ton

Blv

d.30

3-32

7-40

91Li

ttlet

onO

rthod

ontis

tN

/A

Dr.

Irina

A L

ovin

escu

Littl

eton

Fam

ily O

rthod

ontic

sN

ot N

eede

d92

00 W

est C

ross

Driv

e, S

te #

426

303-

972-

2898

Littl

eton

Orth

odon

tist

N/A

Dr.

Eun

ice

P. L

eeS

outh

park

Orth

odon

tics

Not

Nee

ded

8199

Sou

th P

ark

Lane

, #15

030

3-73

8-88

28Li

ttlet

onO

rthod

ontis

tN

/A

Dr.

Fazi

la D

urki

nD

urki

n O

rthod

ontic

sN

ot N

eede

d74

30 P

ark

Mea

dow

s D

r.30

3-79

9-88

82Lo

ne T

ree

Orth

odon

tist

N/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - L

ongm

ont

Not

Nee

ded

15 K

en P

ratt

Blv

d., #

280

303-

678-

1155

Long

mon

tO

rthod

ontis

tN

/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - L

ongm

ont

Not

Nee

ded

15 K

en P

ratt

Blv

d., #

280

303-

678-

1155

Long

mon

tO

rthod

ontis

tN

/A

Dr.

Gar

y D

ixon

Sm

ile Z

one

Orth

odon

tics

Not

Nee

ded

1075

S. B

ould

er R

d., #

235

303-

604-

0300

Loui

svill

eO

rthod

ontis

tN

/A

Dr.

Dav

id H

amul

aH

amul

a O

rthod

ontic

sN

ot N

eede

d18

60 W

oodm

oor D

r. #2

0071

9-48

8-37

37M

onum

ent

Orth

odon

tist

N/A

Dr.

Andr

ey N

azar

ovA

llegr

o O

rthod

ontic

sN

ot N

eede

d10

450

S. P

rogr

ess

Way

, #10

072

0-84

2-45

44Pa

rker

Orth

odon

tist

N/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - P

arke

rN

ot N

eede

d11

183

S. P

arke

r Rd.

, #c

303-

209-

2245

Park

erO

rthod

ontis

tN

/A

Dr.

Ran

dall

Sny

der

Com

fort

Den

tal -

Pue

blo-

Sou

thN

ot N

eede

d12

21 S

. Pue

blo

Blv

d.71

9-56

5-22

74Pu

eblo

Orth

odon

tist

N/A

Dr.

How

ard

Stri

nger

tD

r. H

owar

d S

tring

ert

Not

Nee

ded

3955

San

delw

ood

Lane

719-

564-

3333

Pueb

loO

rthod

ontis

tN

/A

Dr.

Ran

dall

Sny

der

Com

fort

Den

tal -

Sum

mit

Cou

nty

Not

Nee

ded

354

Blu

e R

iver

Pkw

y, #

a97

0-26

2-22

73Si

lver

thor

neO

rthod

ontis

tN

/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - T

horn

ton

Not

Nee

ded

951

E. 1

20th

Ave

., #d

303-

305-

4466

Thor

nton

Orth

odon

tist

N/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - T

horn

ton

Not

Nee

ded

951

E. 1

20th

Ave

., #d

303-

305-

4466

Thor

nton

Orth

odon

tist

N/A

Dr.

Jam

es H

. Mas

onC

olo

Orth

odon

tics

Not

Nee

ded

3984

E. 1

20th

Ave

.30

3-42

8-88

00Th

ornt

onO

rthod

ontis

tN

/A

Dr.

Jam

es H

. Mas

onC

olo

Orth

odon

tics

Not

Nee

ded

901

E. 1

20th

Ave

., #e

303-

428-

8800

Thor

nton

Orth

odon

tist

N/A

Dr.

John

Bai

ley

Col

o O

rthod

ontic

sN

ot N

eede

d39

84 E

. 120

th A

ve.

303-

428-

8800

Thor

nton

Orth

odon

tist

N/A

Dr.

John

Bai

ley

Col

o O

rthod

ontic

sN

ot N

eede

d90

1 E.

120

th A

ve.,

#e30

3-42

8-88

00Th

ornt

onO

rthod

ontis

tN

/A

Dr.

Col

in G

ibso

n1s

t Im

pres

sion

s O

rthod

ontic

sN

ot N

eede

d13

33 W

. 120

th A

ve.,

#303

303-

452-

2277

Wes

tmin

ster

Orth

odon

tist

N/A

Dr.

Irina

A L

ovin

escu

Brig

ht N

ow D

enta

l - W

estm

inst

erN

ot N

eede

d30

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erO

rthod

ontis

tN

/A

Dr.

Kel

van

C L

uff

Brig

ht N

ow D

enta

l - W

estm

inst

erN

ot N

eede

d30

03 W

. 104

th A

venu

e30

3-41

0-98

00W

estm

inst

erO

rthod

ontis

tN

/A

Pag

e 23

of 2

4

Page 31: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Alp

ha D

enta

l Pla

n C

ompl

ete

Pro

vide

r Dire

ctor

y an

d O

rthod

ontis

ts10

/23/

2014

NAME

OFFI

CE N

AME

PROV

IDER

#AD

DRES

SPH

ONE

CITY

SPEC

IALT

YCO

DES

Dr.

Gar

y D

ixon

Sm

ile Z

one

Orth

odon

tics

Not

Nee

ded

9910

Wad

swor

th P

kwy.

303-

430-

4200

Wes

tmin

ster

Orth

odon

tist

N/A

Dr.

Dav

id R

icht

erR

icht

er O

rthod

ontic

sN

ot N

eede

d12

18 W

. Ash

St.

970-

392-

1744

Win

dsor

Orth

odon

tist

N/A

Dr.

Bra

dley

E. G

oing

sW

inds

or S

mile

s O

rthod

ontic

sN

ot N

eede

d12

18 W

. Ash

St.,

Uni

t D97

0-46

0-07

91W

inds

orO

rthod

ontis

tN

/A

Dr.

Sha

wn

Mur

ray

Win

dsor

Sm

iles

Orth

odon

tics

Not

Nee

ded

1218

W. A

sh S

t., U

nit D

970-

460-

0791

Win

dsor

Orth

odon

tist

N/A

botto

m p

age

Code

Def

initi

ons:

* -Th

is of

fice p

rovid

es ni

trous

oxid

e.

C -T

his o

ffice

acce

pts m

ost c

hild

ren o

ver t

he ag

e of 4

for r

outin

e car

e. P

lease

chec

k with

your

se

lecte

d den

tal o

ffice

for t

heir

spec

ific g

uide

lines

.

E1-2

-Thi

s offi

ce w

ill pr

ovid

e mos

t 1 an

d 2 c

anal

root

cana

l pro

cedu

res d

epen

ding

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4

Page 32: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Check out these Free National Discount Programs!

All employees and dependents enrolling in one of the attached dental plans can use any of the attached programs free of charge. It is our thanks to you for using Beta Health as your dental carrier!

Simply follow the instructions on the attached discount program description sheets….it’s that easy. You can photocopy these items and distribute to all of your dependents as well.

If you have questions, please call Beta Health at 303-744-3007 or 1-800-807-0706.

Page 33: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Introducing Discount Services for Dental Plan Members Free of Charge

The Vision Discount Plan

Vision Care Services In Network Only Exam with Dilation (as necessary) $5 off exam Contact Lens Fit and Follow-up Standard $10 off exam Premium $10 off exam Frames When a complete pair of glasses is purchased (frame, lenses and lens options purchased in the same transaction) a 35% discount will apply.* Standard Plastic Lenses Member Pays Single Vision $50 Bifocal $70 Trifocal $105 Lens Options Member Pays UV Coating $15 Tint (Solid and Gradient) $15 Standard Scratch Resistant Coating $15 Standard Polycarbonate $40 Standard Anti-Reflective Coating $45 Standard Progressive (Add-on to Bifocal) $65 Other Add-ons and Services 20% off retail Contact Lens Materials (Discount applied to materials only) Conventional 15% off retail price Disposable no discount Laser Vision Correction** Lasik or PRK 15% off retail price or 5% promotional price Frequency Examination Unlimited Frame Unlimited Lenses or Contact Lenses Unlimited

* Items purchased separately will be discounted 20% off of the retail price. ** Since Lasik or PRK vision correction is an elective procedure, performed by specially trained providers, this discount may not always be available from a provider in your immediate location.

For a location near you and the discount authorization, please call 1-877-5LASER6.

Beta Health Association, Inc. has teamed up with EyeMed Vision Care to offer easy access to over 43,000 national, conveniently lo-cated vision care providers including optometrists, ophthalmologists, opticians and many leading optical retailers, such as LensCrafters®, Target Optical®, and most Sears Optical® and Pearl Vision® locations. This benefit is free of charge for Beta Health Dental Plan members. Note that this is not insurance, only a discount plan to save you and your family members $ as needed!

Page 34: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

This hearing care program combines unlimited choices with quality and value. It’s provided free of charge to all employees and family members enrolled in a Beta Health Association, Inc. dental plan. Beta Health and EPIC Hearing Health Care give you easy access to a large national network of thousands of hearing care professionals — primarily physicians and audiologists — who can help you

achieve your maximum hearing potential throughout your life. The prices you get from EPIC may be as much as 50% below the manu-facturer’s suggested retail price and up to 35% lower than most discount offers. EPIC can coordinate the coverage with your existing

healthcare plan. Note that this is not insurance, only a discount plan to save you and your family members $ as needed!

Introducing Discount Services for Dental Plan Members Free of Charge

The Hearing Discount Plan

To activate your hearing discount plan, call EPIC Hearing Health at 1-866-956-5400. EPIC will send you a card with all the information you need to access your benefits, including referrals to providers near you and activation forms to access them. Tell them that you are a Beta Health member and you will be connected to a personal EPIC phone contact who can answer any questions you may have. A booklet that outlines the plan benefits (as well as pricing) will be mailed to your home. Then you will follow through with an appointment, examination and treatment. All payments should be made to EPIC HSP. No other billing or payments should occur. Contact EPIC at any time for assistance, advice and information.

Check out these benefits and savings! The hearing discount plan benefits and savings are:

Hearing tests Hearing aids, aid cleaning supplies, accessories and batteries

Ear protection, swim and musician earplugs Assistive listening devices

TV ears (amplifies and clarifies television) Alerting and signaling devices

The Prescription Drug Discount Plan Do you want to SAVE an average of 10% to 85% on the cost of prescription medications? With the HealthTrans nationwide national discount prescription drug program this is easy!

To use your HealthTrans discount drug card: 1.) Write in your specific member I.D. number on the member I.D. cards (attached) for use at the pharmacy.

2.) Take your card and prescription(s) to a participating pharmacy. Pharmacy locations can be found at the web site below. 3.) Pay the pharmacy the negotiated reduced discount!

Note that this is not insurance, only a discount plan to save you and your family members $ as needed!

It’s simply a great way to save money on prescription drugs! After working closely with pharmacies and drug manufacturers, HealthTrans has negotiated lower prices for thousands of medications, and have passed these savings on to all Beta Health

Association members and their families. The average discounts range from up to 16% on brand name and up to 55% on generic drugs. There are no limits on quantities and no paperwork to complete. Discounts are available at over 55,000 pharmacies nationwide and are

also available to the entire family on an as needed basis!

See how much you can save today by going to http://cashcard.lc.healthtrans.com

Page 35: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

Thank you for choosing Beta Health Association, Inc. as your dental partner. We are proud to offer you, free of charge, the EyeMed® Vision Discount Plan, the Epic Hearing Health® Plan and the HealthTrans® Prescription Discount Plan. Please use the ID cards provided below to access these “Free of Charge” benefits. Follow all instructions as identified on each set of cards. We appreciate our relationship!

EyeMed Group Number: 9235409 Group Name: Beta Health Association, Inc.

Member Name: ______________________________________

Call 1-866-723-0596 to locate the nearest EyeMed Provider. This is a discount program and not insurance.

EyeMed Group Number: 9235409 Group Name: Beta Health Association, Inc.

Member Name: ______________________________________

Call 1-866-723-0596 to locate the nearest EyeMed Provider. This is a discount program and not insurance.

Epic Hearing: Call 1-866-956-5400 for ID card information. Group Name: Beta Health Association, Inc.

Member Name:

This is a discount program and not insurance.

Epic Hearing: Call 1-866-956-5400 for ID card information. Group Name: Beta Health Association, Inc.

Member Name:______________________________________

This is a discount program and not insurance.

BIN #: 011867 Group ID: DDS01 Member ID: _________________ Please enter your initials &

the last four digits of your phone #) Member Name: _________________________________________ This is a discount program and not insurance. Visit http://cashcard.lc.healthtrans.com for more information or call 877-459-8474.

BIN #: 011867 Group ID: DDS01 Member ID: _________________ Please enter your initials &

the last four digits of your phone #) Member Name: _________________________________________ This is a discount program and not insurance. Visit http://cashcard.lc.healthtrans.com for more information or call 877-459-8474.

Page 36: Alpha Dental Plan of Colorado - E3 Solutions, LLCe3forvb.com/wp-content/uploads/2014/12/Stellar-Alpha-Only-2015... · Alpha Dental Plan of Colorado Employee Enrollment Packet BBB

9725 E Hampden Avenue #400Denver, CO 802311-800-807-0706 (Phone)303-744-2890 (Fax)

� New Employee � Change Address� COBRA � Change Dependent Status

� Terminate*

ALPHA DENTAL PLANGROUP ENROLLMENT, WAIVER,AND CHANGE REQUEST FORM

TO BE COMPLETED BY EMPLOYER

TO BE COMPLETED BY EMPLOYEES ELECTING TO ENROLL

COMPLETE FOR DENTAL

Name of Employer (Use Name from Group Billing Notice or Master Application)

Social Security Number Effective DateMonth Day Year

Date of HireMonth Day Year

Date of BirthMonth Day Year

Phone #

Work: ______________

Home: ______________

Your Name Last First M.I. Gender� Female� Male

Marital Status� Single� Married

Dental Options (please check your selection)

Alpha Dental Plan only** � Provider Selection: ADP #

**You must select a plan provider for all services. Please visit www.betadental.com for a current provider directory. The Alpha Dental plan is a discountfee for service dental plan and is in no way considered insurance. Alpha Dental providers can be changed at any time by calling 303-744-3007 or 1-800-807-0706.

Your Home Address City State Zip Code

E-mail Address:

Is your spouse to be enrolled? � Yes � No

Are you enrolled in anyother dental plans? � Yes � No

Complete for Dependent(s) Full-time Gender Do any of your dependents have any other Spouse Name (Last) (First) (Middle Initial) Student Y/N Date of Birth M or F dental plan? If Yes, Name of Carrier

/ / � Yes � No

/ / � Yes � No

/ / � Yes � No

/ /

/ /

/ /

/ /

� Yes � No

� Yes � No

� Yes � No

� Yes � No

DEPENDENT

(S)

1

2

3

4

5

6

Date Your SignatureX

10/08

Beta Health Group #

It is unlawful to knowingly provide false, incomplete, or misleading facts on this form or to defraud or attempt to defraud Beta Health or one of their partners. Penalties may include impris-onment, fines, denial of services and civil damages. Please report any organization or agent who you feel knowingly provides false, incomplete or misleading facts for the purpose ofdefrauding the participants to the Colorado Division of Insurance. I also agree to remain on the plan for a minimum of one year or until the next open enrollment period (which ever comesfirst). The only exception to this is if I loose employment (either voluntarily or involuntarily).

DENTAL PLAN WAIVERI have been offered the above dental plan options and I am declining participation at this time. I also understand that the next time that I may enrollin one of these plans is at the next open enrollment period only (one year from now). The only exception to this is if a qualifying event occurs.

Date Signature of Employee

* Can only terminate at open enrollment or if employment is terminated.

Enrollment Selection (Check the Correct Box Below): � Employee Only � Employee Plus � Employee � Employee

Spouse Plus Child(ren) Plus Spouse and Child(ren)

FOUR TIER