Washington Dental Service is committed to protecting our communities against insurance fraud. This page enables individuals to report suspicious activity anonymously. Please be advised that reported suspicious activity cannot be investigated if sufficient information is not provided. Contact information is not required, but can help Washington Dental Service avoid the inability to take action on any report.

Reporting on: (Choose one)
Dental OfficeSubscriberEmployee
Doctor Information (Required if reporting on dentist/dental office)
Doctor Name:
Doctor Address:
Doctor Phone:
City:	State: Select State Not USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Subscriber Information (Required if reporting on subscriber)
Subscriber Name:
Subscriber Address:
Subscriber ID:
City:	State: Select State Not USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Claim Information
Claim #:(if applicable)
Tx Date:	Paid Date:
Group Number:
Report Details:
Description of issue: