Enrollment Forms





Agent Forms



Cancellation Forms



You can mail or fax forms to:
Professional Benefit Administrators
1000 Hurricane Shoals Road
Suite C 370
Lawrenceville, GA 30043
Phone: (770) 963-3939
Toll-free: (800) 578-2082
Fax: (770) 963-6126
Toll-free Fax: (888) 264-6975
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Dental Plans offered in Washington DC
Choose a carrier below for more information on benefits and costs.
Careington Discounted Dental
Diamond 1500
Dominion 703X
Humana PPO
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