Gold Plan Application

     Section

1. Overview 2. Your Info 3. Location 4. Plan Type 5. Payment Info 6. Review

Information about the Gold Plan

Comfort Dental Gold Plan is a reduced-fee dental membership plan that allows individuals and families to receive quality dental services from Comfort Dental dentists at reduced prices. The Gold Plan offers the access of a network, plus the individualized attention of private care. You, your spouse, dependent children up to 26 years of age, and children over 26 with a developmental disability or physical handicap are eligible. Individuals under the age of 18 may only be members as the dependents of adults.

Members must choose a provider/office from the list of OFFICE LOCATIONS provided in this form. Provider information is also available at www.comfortdental.com or by calling the Gold Plan office. To receive care, simply call your selected office for an appointment after your effective date. All Comfort Dental Offices offer EVENING AND SATURDAY appointments.

Members who enroll prior to the 10th of the month will have their membership begin on the first day of the following month. Those enrolling after the 10th will have their membership begin on the first day of the second month.

This discount program is NOT a health insurance policy and does not make payments directly to dental service providers. Members are obligated to pay for all dental services, but may receive discounts on dental services from participating providers and the discount range will vary depending on provider type and dental services received. The program does not meet the minimum creditable coverage requirements under any law and is not a Qualified Health Plan under the Affordable Care Act. If you cancel within the first 30 days after activation you will receive a full refund, except for the $10 processing/enrollment fee where permitted by law.

Administration

Comfort Dental’s Gold Plan program is administered by:

Comfort Dental Gold Plan, LLC
2540 Kipling St., Lakewood, CO 80215
(303) 232-2300 Ext. 102, 103 or 113 in Colorado
1-800-742-8710 Ext. 102, 103 or 113
goldplan@comfortdental.biz

Members who cancel after receiving benefits may be liable for the difference between the Gold Plan fee and the provider’s normal and customary fee for treatment, payable to the provider.

Members may change providers or add additional family members by providing a written request and paying any additional membership fees. Changes will be effective 30-days from the receipt of written requests.

Feedback

Complaints should be addressed to:

Comfort Dental Gold Plan Customer Service
2540 Kipling St., Lakewood, CO 80215

Complaints will be addressed within 30-days of receipt. If a member remains dissatisfied he or she may contact his or her state’s insurance department. The Gold Plan does not guarantee the quality of the services or products offered by individual providers.

Gold Plan Inclusions

Gold Plan Membership provides you with local anesthetics, examinations, x-rays, and other preventive services at NO CHARGE ($5.00 for Arizona members) plus reduced fees on most other dental services. The Reduced Fee Schedule is included and can also be viewed at www.comfortdental.com/patient-center/gold-plan/ for full details on discounted services.

Members are charged an office visit fee of $25.00 for each appointment. Orthodontics (BRACES) are provided at $129/month for children and $139/month for adults with NO DOWN PAYMENT. The reduced fees are paid directly by you to your selected provider. A complete list of dentists and offices is available at www.comfortdental.com.

Members may receive emergency dental care for the relief of pain, bleeding or swelling from any Comfort Dental dentist at any Comfort Dental office when their selected provider is unavailable.

This contract is not protected by any state guaranty fund. The program and program administrator is not liable for providing or guaranteeing health services or for the quality of health services rendered. Membership and activation fees apply. The Gold Plan is governed by this Membership Agreement. Participating providers are not available in all areas and are subject to change without notice. Program is not available in all states.

 



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Choose Location

Please select your Dental Office Location. Note: each office is owned and operated by an independent Franchisee.

Show All States

Arizona

East Mesa

407 N. Lindsay Mesa, AZ 85213

480-218-9720

Scottsdale

6949 E. Shea Blvd. Ste.100 Scottsdale, AZ 85254

480-459-2144

West Mesa

1130 S. Country Club Dr. Ste. 101 Mesa, AZ 85210

480-461-9866

Colorado

80th & Sheridan

7990 Sheridan Blvd Westminster, CO 80030

303-650-4101

Arvada

12380 W 64th Ave Arvada, CO 80004

303-421-7000

Aurora

1050 S Peoria Aurora, CO 80012

303-367-2273

Avon

0101 Fawsett Rd Unit 170 Avon, CO 81620

970-949-7911

Bear Creek

3200 S Wadsworth Blvd Lakewood, CO 80227

303-716-8546

Belleview and Simms

11625 W Belleview Ave Littleton, CO 80127

303-972-8700

Boulder

3400 Arapahoe Rd. Boulder, CO 80303

303-444-2129

Brighton

315 East Bromley Lane Brighton, CO 80601

303-659-1125

Centennial

8223 S Quebec Centennial, CO 80112

303-689-2273

Cherry Creek

201 University Blvd #101 Denver, CO 80206

303-321-2233

Citadel

509 N Academy Colorado Springs, CO 80909

719-591-7599

Coal Mine

8420 W Coal Mine Ave Littleton, CO 80123

303-904-2273

Commerce City

7201 N Monaco Commerce City, CO 80022

303-287-2755

Conifer

25597 Conifer Rd Ste 100 Conifer, CO 80433

303-838-2811

Denver

4450 W. 38th Denver, CO 80212

303-455-2273

Down town Denver

1512 Larimer St Unit 10 R Denver, CO 80202

303-872-4685

Durango

1125 S Camino Del Rio Ste 300 C Durango, CO 81303

9702594324

East Aurora

2131 S Chambers Aurora, CO 80014

303-750-2273

East Colfax

5200 E. Colfax Denver, CO 80220

303-377-3876

Englewood

2780 S Broadway Englewood, CO 80110

303-783-0100

Evergreen

1232 Bergen Pkwy Evergreen, CO 80439

303-674-6070

Falcon

11605 Meridian Marker View Peyton, CO 80831

719-495-8989

Firestone

4415 City Centre Rd Ste. 400 Firestone, CO 80504

303-651-6347

Ft. Collins

934 S. Lemay Ft. Collins, CO 80524

970-498-8300

Golden

17531 S. Golden Rd Golden, CO 80401

303-278-6953

Grand Junction West

2502 Hwy 6&50 #700 Grand Junction, CO 81505

970-241-2080

Greeley

3766 W. 10th St Greeley, CO 80634

970-304-1273

Greeley University Square

2716 11th Ave Greeley, CO 80631

970-673-4310

Green Mountain

12810 W. Alameda Pkwy. Ste. A Lakewood, CO 80228

303-987-2273

Green Valley Ranch

18620 GVR Blvd. Ste. 103 Denver, CO 80249

303-371-8247

Highlands Ranch

91 W. Mineral Ave. Unit 150 Littleton, CO 80120

303-738-9499

Lafayette

535 W. S. Boulder Rd Ste. 200 Lafayette, CO 80026

303-604-2804

Lakewood

6800 W. Alameda Lakewood, CO 80226

303-727-9100

Littleton

209 W. Littleton Blvd. Littleton, CO 80120

303-734-2273

Longmont

1750 Mountain View Longmont, CO 80501

303-678-7783

Louisville

339 McCaslin Blvd. Unit B Louisville, CO 80027

303-673-0500

Mile High

881 Federal Blvd. Denver Co, CO 80204

303-825-0013

Montrose

1807 S Townsend Ave Montrose, CO 81401

970-744-2936

Monument

556 W. Hwy 105 Monument, CO 80132

719-484-0043

North Academy

1634 York Rd Colorado Springs, CO 80918

719-522-0800

North Arvada

8390 W. 80th Ave. Arvada, CO 80005

303-425-6419

North Boulder

4550 Broadway Unit C 3 E Boulder, CO 80304

303-848-2906

North Loveland

274 W. 64th St. Loveland, CO 80525

970-667-0446

North Powers

6076 Stetson Hills Blvd. Colorado Springs, CO 80922

719-637-2079

North Pueblo

2025 US Hghwy 50 #130 Pueblo, CO 81008

719-542-2472

North Westminster

11187 Sheridan Blvd #12 Westminster, CO 80260

303-469-2333

Northglenn

10780 N. Washington Ave. Northglenn, CO 80233

303-425-6630

Parker Road

15250 E. Orchard Rd. Centennial, CO 80016

303-680-9990

Quincy and Buckley

16981 E. Quincy D1-D3 Aurora, CO 80015

303-617-8400

S.E. Denver

3488 S Willow St Denver, CO 80231

303-338-8181

Security

332 Main St Colorado Springs, CO 80911

720-907-0683

Smokyhill

24500 E Smokyhill Aurora, CO 80016

303-945-3364

South College

4032 S College Ave. Ft. Collins, CO 80525

970-225-2273

South Powers

1580 Space Center Colorado Springs, CO 80907

719-574-8922

Stroh Ranch

12870 Stroh Ranch Ct Parker, CO 80134

303-840-6543

Thompson Valley (Loveland)

1405 10th SW Loveland, CO 80537

970-962-9995

Thornton

9203 Huron Thornton, CO 80260

303-429-2273

Tower Road

18680 E Iliff Ave. Ste. A.B. Aurora, CO 80013

303-751-5010

Westminster

10350 Federal Blvd Federal Heights, CO 80260

303-427-2722

Wheatridge

9990 W 26th Ave Lakewood, CO 80215

303-425-2300

Windsor

700 Main St Ste B Windsor, CO 80550

970-373-5730

Kansas

Overland Park

8700 Santa Fe Drive Overland Park, KS 66212

913 416 4660

Roeland Park

5201 Roe Blvd. Roeland Park, KS 66205

913-828-0060

State Avenue

7933 State Avenue Kansas City, KS 66112

913-213-6973

Missouri

Grandview

12200 15th St Suite 106 Grandview, MO 64030

816-398-8046

Montana

Billings

918 Grand Ave Billings, MT 59102

406-625-3000

Kalispell

2165 Hwy. 2 East Ste. D Kalispell, MT 59901

406-890-7040

Nebraska

Mockingbird Hills

5305 S. 96th St. Omaha, NE 68127

402-331-7130

New Mexico

Alameda

1125 Alameda Blvd NW Albuquerque, NM 87115

505-933-6873

Central

13031 Central Blvd. NE Albuquerque, NM 87123

505-332-2273

Coronado

5820 Menaul Coraonado Blvd. NE Albuquerque, NM 87110

505-872-2772

East Paseo Del Norte

7900 San Pedro Suite C-5 Albuquerque, NM 87109

(505) 933-6871

North Valley

5308 4th St NW Albuquerque, NM 87107

505-341-2273

Rio Bravo

1698 Rio Bravo SW Albuquerque, NM 87105

505-247-2717

Riorancho

2003 Southern Blvd Suite 133 Rio Rancho, NM 87124

505-221-5740

Santa Fe

3811 Cerrillos Rd North Unit Santa Fe, NM 87046

505-933-6872

Ohio

Circleville

915 S Court St. Circleville, OH 43113

740-334-4116

Gahanna

4693 Morse Rd Gahanna, OH 43230

614-471-7800

Grove City

2196 Stringtown Rd Grove City, OH 43123

614-875-1100

Hamilton

954 Main St Hamilton, OH 45013

513-716-1362

Heath

740-788-8084 Heath, OH 43056

740-788-8084

Hilliard

3676 Main St. Hilliard, OH 43026

614-453-2806

Lakewood(Ohio)

17500 Madison Ave Lakewood, OH 44107

2163022401

Lancaster

1601 N Memorial Dr Lancaster, OH 43130

740-521-4142

North Columbus

2610 E Dublin-Granville Rd Columbus, OH 43231

614-794-7480

Sawmill

6301 Sawmill Rd Dublin, OH 43016

614-764-0400

Whitehall

4545 E Main St Whitehall, OH 43213

614-231-1600

Xenia

44 Xenia Town Sq Xenia, OH 45385

937-410-0451

Oklahoma

Midwest City

7100 SE 15th St Midwest City, OK 73110

405-241-9960

Moore

1060 SW 4th St Moore, OK 73160

405-384-7071

North May

5920 N. May Ave. Oklahoma City, OK 73112

405-494-4961

Texas

Addison

3744 Beltline Rd. Addison, TX 75001

972-243-3948

Babcock

6565 Babcock Rd Suite 1 San Antonio, TX 78249

210-904-2888

Converse

9135 Schaefer Rd, Ste. 3 Converse, TX 78109

210-607-8232

Denton

612 W. University Dr. Denton, TX 76201

940-484-1200

Frisco

8745 Gary Burnes Dr, Ste. 154 Frisco, TX 75034

214-494-4441

Hulen

6217 Oakmont Blvd Fort Worth, TX 76132

682-224-1464

Mesquite

540 Clay Mathis Mesquite, TX 75181

972-222-5313

Munger

5004 Columbia Ave, Ste 101 Dallas, TX 75214

8175555555

Richardson

516 W. Arapaho Ste. 103 Richardson, TX 75081

972-231-5020

Rockwall

515 E I-30 Rockwall , TX 75087

214-771-4603

Stoneoak

203 N. Loop 1604 Ste. B-1 San Antonio, TX 78232

210-490-8300

Thousand Oaks

3023 Thousand Oaks Dr. Ste. B-1 San Antonio, TX 78247

210-497-6700

West Ave

4812 West Ave Ste101 San Antonia, TX 78213

210-977-0321

 

Dependents

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Personal Information

Name:
first name last name
Address:
address
city, state code
Email:
email
Phone:
303-716-8546
Birthdate:
06/27/1979
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Plan Type

Plan Type:
Family
Dependents:
Virginia Chance
James Chance
Hope Chance
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Location

Name:
Austin Bluffs
Address:
3952A N Academy
Phone:
719-591-1811
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Payment Info

Payment Type:
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