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Print the enrollment form with your browsers print command.
After completing the form mail along with your first premium payment to:

Group Benefits, Inc.
21 Nob Hill Drive, Lower Level
St. Louis, MO 63138

Telephone: 314-438-0222

or

Dental Source
9091 State Line - Suite 101
Kansas City, MO 64114

Telephone: (816) 523-8900

If you have any questions please call.

All checks should be made payable to DENTAL SOURCE.