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Home > Malpractice > Dental Malpractice Insurance Quote
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Dental Malpractice Insurance Quote


It only takes a few minutes to request a quote.

Compare our rates and coverage before you renew your current insurance.

Yes, I am interested in receiving a Coverage and Rate Quotation for my practice. I understand that I am under no obligation by requesting this information.



Company Information
Company Name *
First Name *
Last Name *
Street *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
Fax Number
E-Mail Address *
Best time to contact
How would you like to receive your quote?


A. AVAILABLE PREMIUM CREDITS
Check (4) all that apply












Organizations
B. PROFESSIONAL LIABILITY COVERAGE
I am currently Insured *

If claims-made, what is your retroactive date? *
/ /
Please quote *


DENTAL PROFESSIONAL LIABILITY LIMITS - Please check desired limit option






Requested effective date *
/ /
Are you a General Dentist? *

If limiting your practice to a specialty, are you licensed in that specialty? *

Level of Sedation Used *
What is your specialty?








Please provide the percentages (based on number of procedures) of your practice which fall into the following CDT codes (must total 100%)
Diagnostic - D0100 - D0999
Preventive - D1000 - D1999
Restorative - D2000 - D2999
Endodontics - D3000 - D3999
Periodontics - D4000 - D4999
Prosthodontics (Removable) - D5000 - 5899
Maxillofacial Prosthetics - D5900 -D5999
Implant Services - D6000 -D6199
Prosthodontics (Fixed) - D6200 -D6999
Oral and Maxillofacial Surgery - D7000 - D7999
Orthodontics - D8000 -D8999
Adjunctive General Services - D9000 -D9999
Do you perform any surgical procedures? *

If "yes," please estimate the percentage each surgical procedure bears to your total practice (based on numbers of procedures) on an annual basis.
Surgical Implants
Extractions of bony impacted, or partially bony impacted teeth
Other dental cosmetic procedures (excluding biopsies, but including T MJ)
Other surgery, including non-dental procedures (describe)
I administer the following types of Anesthesia. (Please check all that apply)



Have you ever had any disciplinary action, restriction, suspension, probation or revocation of a license to practice dentistry? *

Other than traffic violations, have you ever been convicted of a crime? *

Have you ever been declined or cancelled for any Dental Professional Liability Insurance? (Missouri residents: Do not respond)
In the past 10 years, have you been involved, directly or indirectly, in a claim or suit arising out of the rendering or failure to render professional services? *
If Yes, how many (Open and Closed)
Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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2430 Camelot Ct SE
Grand Rapids, MI 49546

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