Request Appointment Control Number
Friday, March 28, 2025
Request Appointment Control Number
To coordinate your routine covered dental care, you must first get an Appointment Control Number (ACN). Complete the form below to instantly receive your ACN and approval to schedule your care with a United Concordia network dentist.
Fields with asterisks (
*
) are required.
Member Information
*
First Name:
*
Last Name:
*
ID Number
Social Security Number:
- OR -
Benefits Number:
Benefits Number - 11-digit number listed on the back
of the member's CAC card (see below).
*
Date of Birth:
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