Prepaid Plan - The University of Tennessee, Knoxville

Prepaid PlanDental Benefit Option

Sponsored by the State of TennesseeProducts and services marketed by AssurantEmployee Benefits are underwritten and/orprovided by Union Security Insurance Company.

2007

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A Dental Plan Means HealthySmilesBecause you are a valued participant in the Stateof Tennessee Group Insurance Program, we arepleased to offer you the opportunity to enroll ina dental benefit plan. This dental program is aPrepaid Plan, offering comprehensive benefitsthrough a network of Plan dentists. Your dentalbenefit plan is being provided by Union SecurityInsurance Company.

Prepaid Plan Features:• No Deductibles

• No Claims to File

• No Annual Dollar Maximum

• No Waiting Periods for Covered Members

• Coverage for Pre-Existing Conditions

• Worldwide Emergency Coverage

• Wide Range of Covered Procedures

How the Plan WorksIn order to utilize the benefits of the PrepaidPlan you must select a Participating GeneralDentist from the directory which begins onpage 5 of this booklet. When you or your familyreceive dental services from your selectedParticipating General Dentist or from aParticipating Specialist, you will be charged forthose services according to the General Dentistor Specialist Copayment Schedules. Copaymentsare reduced fees that you pay the dentist for thetreatment you receive. For your convenience, apartial list of some of the most frequently useddental treatments and copayments is included inthis booklet.

Enrollment InformationTo enroll, just follow these three simple steps:1. Complete the appropriate sections of the State

of Tennessee enrollment/change applicationand return it to your agency’s insurancepreparer.

2. Select a dentist from the Directory of Dentistsfor yourself and every eligible member of yourfamily. Each family member may choose adifferent Plan dentist. You may change yourdentist throughout the plan year,* however, allservices must be performed by a Planprovider. (See the “Questions & Answers” onpage 4 for additional information.)

3. Complete the Dentist Selection Card on theback cover of this booklet, being sure toinclude the 7-digit Dental Facility ID# for theParticipating General Dentist you select. (A listof General Dentists participating with the PrepaidPlan is included in this booklet.) Detach andreturn the card directly to your agency’sinsurance preparer. In order to receive thebenefits of the Prepaid Plan you must select aParticipating General Dentist.

*Changes must be made in accordance withgroup policy provisions.

Good News about dental benefits for participants in

the State of TennesseeSponsored Prepaid Dental Plan

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IMPORTANT: Coverage for eligible employees anddependents will begin January 1, 2007. The Annual Enrollment Transfer Period(October 16 through November 15) is the time when you and your eligible dependentshave the opportunity to enroll in the PrepaidPlan option. If you fail to enroll during theAnnual Enrollment Transfer Period, youmust wait until next year. Please note that ifyou are presently enrolled in the PrepaidPlan and wish to remain in this plan, youneed not take any action.

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Monthly Payroll Deduction

Employee $8.90

Employee and One Dependent $15.78

Employee and Two or More Dependents $21.70

The following are partial lists of some of the mostfrequently used dental treatments. When you enroll forcoverage, treatments you receive from your ParticipatingGeneral Dentist or Participating Specialist will beprovided at reduced fees called copayments. Followingenrollment, a complete list of Prepaid Plan Copaymentsfor General Dentists and Specialists will be mailed toyour home with your Certificate of Group PrepaidDental Benefits.

Copayment Schedule for Participating General Dentists

IMPORTANT INFORMATION1. Participating General Dentist ServicesThe dental services listed on the Copayment Schedule arecovered only when provided by the Member’s selectedParticipating General Dentist. Members will be responsiblefor paying the amount listed in the “Member Copayment”column at the time the service is received, or in accordancewith the Participating General Dentist’s billing procedures.

All procedures listed may not be performed by theParticipating General Dentist you select. The copaymentsshown apply to those Participating General Dentists whoperform those services. Therefore, you are encouraged todiscuss availability of the scheduled services with yourParticipating General Dentist.

2. Participating Specialist ServicesShould a Plan Member require dental services that his/herselected Participating General Dentist is unable to providehe/she may obtain those services from a ParticipatingSpecialist. No referral is needed from the selectedParticipating General Dentist in order for the Member toobtain services from a Participating Specialist.

Specialist Benefits Oral Surgery, Endodontics, Periodontics, Pedodontics:Please see the Participating Specialist Copayment Schedulefor complete details.

Orthodontics: If you are treated by a ParticipatingOrthodontist, you will receive a 25% reduction off thatOrthodontist's usual and customary charges. Payment forservices performed by a non-participating Orthodontist will bethe responsibility of the Member.ADA MemberCode General Dentist Treatment Copayment

Appointments0120 Periodic oral evaluation ....................................No Charge0150 Comprehensive oral evaluation ........................No Charge9430 Office visit (no service) ................................................10.00

ADA MemberCode General Dentist Treatment Copayment

9999 Missed appointment (without 24 hour notice) (Per 30 min, Max $40) ..................................................20.00Diagnostic Dentistry

0210 X-Ray – intraoral, complete series including ....................bitewings ........................................................No Charge

0330 X-Ray – panoramic film .................................... No ChargePreventive Dentistry

1110 Routine prophylaxis – adult (once every 6 mos.) ..................................No Charge

1120 Routine prophylaxis – child (once every 6 mos.) child up to age 18 ..No Charge

1203 Topical application of fluoride – child up to age 18 ........(Prophylaxis not included) ................................No Charge

1351 Application of sealant, per tooth ................................10.001510 Space maintainer (fixed) – unilateral .............. 45.00*1515 Space maintainer (fixed) – bilateral.................. 45.00*1520 Space maintainer (removable) – unilateral .... 85.00*1525 Space maintainer (removable) – bilateral ........ 85.00*

Restorative Dentistry (Fillings/Crowns)Amalgam

2140 One surface, primary or permanent ................No Charge2150 Two surfaces, primary or permanent .......................... 8.002160 Three surfaces, primary or permanent...................... 18.002161 Four surfaces, primary or permanent ...................... 22.00

Resin Filling2330 One surface, anterior.................................................... 25.002331 Two surfaces, anterior .......................................... 35.002332 Three surfaces, anterior........................................ 45.002335 Four or more surfaces, anterior .......................... 55.002391 One surface posterior .......................................... 55.002392 Two surfaces, posterior ................................................70.002393 Three surfaces, posterior ............................................90.002394 Four or more surfaces, posterior ............................105.002750 Crown – Porcelain to high noble metal ..................275.00*2962 Labial veneer (porcelain laminate) –

laboratory ................................................................300.00*Endodontics Root Canals

3310 Anterior (excluding final restoration) .............. 125.003320 Bicuspid (excluding final restoration)................ 200.003330 Molar (excluding final restoration) .................... 250.00

Periodontics4341 Periodontal Scaling and Root Planing,

four or more....................................................................60.00 contiguous teeth or bounded teeth spaces per quadrant

4910 Periodontal maintenance ............................................45.00Removable Prosthodontics Dentures

5110 Complete upper denture ............................................310.00*5120 Complete lower denture ...................................... 310.00*5211 Partial denture-upper (resin base, including clasps, etc.) ..

..................................................................310.00*5212 Partial denture -lower (resin base, including clasps, etc.)

..................................................................295.00*Fixed Prosthodontics

6750 Crown - Porcelain fused to high noble metal, per unit Unit** ..............................................................275.00*Oral Surgery

7210 Surgical removal of erupted tooth removal/sectioning ......................................................55.00Removal of impacted tooth

7220 soft tissue .................................................................. 65.007230 partial bony ....................................................................75.007240 complete bony ...................................................... 100.007241 complete bony, with complications ..........................125.00

*Members are responsible for additional lab fees forthese services.

Customer Service 800.443.29952

Savings You Can See

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IMPORTANT INFORMATIONParticipating Specialist ServicesShould a Plan Member require dental services that his/herselected Participating General Dentist is unable to provide,he/she may obtain those services from a Participating Specialist.No referral is needed from the selected ParticipatingGeneral Dentist in order for a Member to obtain servicesfrom a Participating Specialist.

All procedures listed may not be performed by the ParticipatingSpecialists you select. The copayments shown apply to thoseParticipating Specialists who perform those services. Therefore,you are encouraged to discuss availability of the scheduledservices with your Participating Specialist.

Services provided by the Participating Specialist that are notincluded in the complete copayment schedule (Form# FB-SCS-TN)will be provided at a 25% reduction in the ParticipatingSpecialist's usual and customary fees. ADA MemberCode Specialist Treatment Copayment

Appointments0120 Periodic oral evaluation ....................................No Charge0150 Comprehensive oral evaluation ..................................20.009430 Office visit (no service) ................................................10.009999 Missed appointment (without 24 hour notice)

(Per 30 min, Max $40)............................................ 20.00Diagnostic Dentistry

0210 X-Ray – intraoral, complete series, including bitewings ........................................................5.00

0330 X-Ray – Panoramic film .............................................. 20.00Preventive Dentistry

1110 Routine prophylaxis –adult (once every 6 mos.) ................................No Charge

1120 Routine prophylaxis – child (once every 6 mos.)Child up to age 18 ........................................................15.00

1203 Topical application of fluoride – child up to age 18..........(Prophylaxis not included) ................................No Charge

1351 Application of sealant, per tooth........................ 10.001510 Space maintainer (fixed) – unilateral .............. 45.00*1515 Space maintainer (fixed) – bilateral.................. 45.00*1520 Space maintainer (removable) – unilateral .... 85.00*1525 Space maintainer (removable) – bilateral ........ 85.00*1550 Recementation of space maintainer .................. 15.00

Restorative Dentistry (Fillings/Crowns)Amalgam

2140 One surface, primary or permanent ............................ 5.002150 Two surfaces, primary or permanent ........................ 10.002160 Three surfaces, primary or permanent...................... 20.002161 Four surfaces, primary or permanent ...................... 22.00

Resin filling2330 One surface, anterior ............................................ 25.002331 Two surfaces, anterior .......................................... 35.002332 Three surfaces, anterior........................................ 45.002335 Four or more surfaces, anterior .......................... 55.002391 One surface posterior ....................................................60.002392 Two surfaces, posterior ................................................75.002393 Three surfaces posterior ..............................................95.002394 Four or more surfaces posterior ................................105.002962 Labial veneer (porcelain laminate) – laboratory ..300.00*

Endodontics Root Canals

3310 Anterior (excluding final restoration)................ 300.003320 Bicuspid (excluding final restoration) ......................425.003330 Molar (excluding final restoration) ..........................600.00

ADA MemberCode Specialist Treatment Copayment

Periodontics4341 Periodontal Scaling and Root Planing, four or more ......

contiguous teeth or bounded teeth spaces per quadrant..................................................................100.00

4910 Periodontal maintenance .................................... 45.00Removable Prosthodontics Dentures

5110 Complete upper denture .................................... 310.00*5120 Complete lower denture ..........................................310.00*5211 Partial denture-upper ............................................................

(resin base, including clasps, etc.) ..........................310.00*5212 Partial denture – lower ..........................................................

(resin base, including clasps, etc.) ..........................295.00*5214 Partial denture – lower ..........................................................

(Cast Metal Framework/Acrylic Base)................ 350.00*Fixed Prosthodontics

6750 Crown – Porcelain fused to high noble metal, per unit Unit** ..............................................................275.00*Oral Surgery

7220 Removal of impacted tooth - soft tissue .............. 65.007230 Removal of impacted tooth - partial bony .......... 75.007240 Removal of impacted tooth - complete bony .... 120.007241 Removal of impacted tooth - complete bony,

Complications with complications..............................140.00

Prepaid Plan Limitations & ExclusionsUnion Security Insurance Company does not providecoverage for the following services:1. Cost of hospitalization, pharmaceuticals and general

anesthesia;2. Services which, in the opinion of a Participating General

Dentist(s) or Participating Specialist(s), are not necessaryfor the patient's dental health; except for those procedureslisted on the copayment schedule as cosmetic procedures;

3. Services that cannot be performed because of the generalhealth of the patient;

4. Treatment which, in the opinion of the ParticipatingGeneral Dentist, must be performed by a non-participatingSpecialist.

5. Any service received from Member's selected ParticipatingGeneral Dentist that is not listed on the complete GeneralDentist Copayment Schedule (Form# FB-GDCS-TN).

How Do I Find Out More?Please call Customer Service at 800.443.2995Monday–Friday 7:00am - 6:00pm (Central Standard Time)This is a sample Member Copayment Schedule only. It is not aCertificate of Group Prepaid Dental Benefits. The Group Policy,which is on file with the Division of Insurance Administration,alone determines all rights and benefits and applicable Limitationsand Exclusions. Following enrollment, a complete list ofPrepaid Plan Copayments for General Dentists andSpecialists will be mailed to your home with yourCertificate of Group Prepaid Dental Benefits whichincludes Prepaid Plan Limitations and Exclusions.

3

Copayment Schedule for Participating Specialists

*Members are responsible for additional lab fees for theseservices.

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Questions and Answersabout the Prepaid Plan

Q. Who is eligible for the Prepaid Plan offered?A. Under the Prepaid Plan you, your spouse and

eligible dependents under the age of 24 are eligiblefor dental coverage. To review dependenteligibility, please refer to your InsuranceHandbook. You may obtain a copy of thishandbook from your agency’s insurance preparer.

Q. How are the dentists selected for participation inthe Prepaid Plan?

A. All dentists who participate in the Prepaid Planhave successfully completed an individualcredentialing process. A review of each dentist’slicense, practice history and infection controlprocedures is performed initially and repeatedperiodically.

Q. Is there a list of dentists that I must choose from?A. In order to receive the benefits of the Prepaid Plan

you must select a Participating General Dentist. Alist of Participating General Dentists is included inthis booklet. You may also select a dentist online atwww.assurantemployeebenefits.com by choosing aprovider from the “DentiCare Network”. Use theDentist Selection Card inside the back cover of thisbooklet to submit your provider selection. Requestsmust be received by the 10th of the month to beeffective the 1st day of the following month.

Q. Why must I select a Participating GeneralDentist?

A. The benefits of the Prepaid Plan are only availablethrough the Participating Provider you select.Should you receive services from a non-Participating Provider, those services will not becovered under the Prepaid Plan.

Q. How can I receive the most current ParticipatingDentist information?

A. You can obtain current Participating Dentistinformation by calling Customer Service at800.443.2995 Monday– Friday 7:00am - 6:00pm(Central Standard Time). If you have internet access,you can also find the most current listing ofParticipating Dentists atwww.assurantemployeebenefits.com.

Q. What are copayments?A. Copayments are reduced fees that you pay directly

to the Participating General Dentist or ParticipatingSpecialist for some dental treatments. A partiallisting of copayments for the Prepaid Plan isincluded on pages 2 and 3 of this booklet.Following your enrollment, a complete list ofPrepaid Plan Copayments for General Dentists andSpecialists will be mailed to your home.

Q. Will I receive an I.D. Card, booklet, etc.?

A. When you enroll for coverage under the PrepaidPlan, you will receive an I.D. Card. A Certificate ofGroup Prepaid Dental Benefits and a completelisting of copayments will be mailed shortlythereafter to your home address.

Q. How do I receive care from my General Dentistunder the Prepaid Plan?

A. After your effective date, contact the ParticipatingGeneral Dentist you selected and tell the office thatyou have the State of Tennessee Prepaid Plan. Theywill schedule your appointment to see the dentist.After you have received treatment from yourdentist, you will be charged according to theCopayment Schedule for the Prepaid Plan.

Q. What if I need to see a Specialist?A. Should the services of a specialist (Oral Surgeon,

Endodontist, Orthodontist, Periodontist orPedodontist) be necessary, you may obtain thoseservice from a Participating Specialist. No referralis needed from your Participating General Dentistin order for you to obtain services from aParticipating Specialist. Tell the ParticipatingSpecialist’s office you have the State of TennesseePrepaid Plan. They will schedule yourappointment.

Q. Are braces covered?A. Yes, under the Prepaid Plan children and adults

may receive Orthodontic services from aParticipating Orthodontist. If you are treated by aParticipating Orthodontist, you will receive a 25%reduction off that Orthodontist’s usual andcustomary charges.

Q. If I leave my employer, can I continue coverage?A. Yes, you will receive a letter from the State

notifying you of the option to continue dentalcoverage through COBRA. After COBRA statusends, members on the Prepaid plan may elect tocontinue coverage on a direct pay basis. Fees maybe paid by monthly bank draft or lump sumannual payments. After conversion, benefits willremain the same as those inforce at the time of theconversion; unless the Member requests otherwise.

Q. May I change General Dentists under the Prepaid Plan?

A. Yes. If you have no balance owed to your currentParticipating General Dentist, you may changedentists on the Prepaid Plan by simply callingCustomer Service at 800.443.2995 Monday–Friday7:00am - 6:00pm (Central Standard Time). No formsor pre-approval are required. You must call by the10th of the month for the change to be effective the1st of the following month.

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PARTICIPATING GENERAL DENTIST DIRECTORY STATE OF TENNESSEE as of August 09, 2006 This directory is subject to change. To verify a Provider’s continued participation or receive the most current listing of Participating Providers call 800.443.2995 Monday – Friday 7 am – 6 pm (CST) or visit our website at www.assurantemployeebenefits.com. City Special Provider/Dentist ID# Phone Address Services

* - Closed to New Patients H – Extended Office Hours B – Bilingual Assistance S – Accepts Specialty Benefit Amendment or Rider

Alcoa

Pasco, Robert DDS 0000237 (865) 982-2330 358 Lindsey St 37701 Algood

Algood Family Dental Group 0015690 (931) 537-9948 172 W Main 38506 /B/ Heard Jr, Richard F DDS

Antioch

Advantage Dental * (615) 731-0700 5245 Hickory Hollow Pkwy 37013 /H/ Jung, Walter J DDS

Edwards Dental Center 0000151 (615) 333-6616 940 Richards Rd, Ste 103 37013 Edwards, Cynthia A DDS

Bartlett

Bartlett Family Dentistry * (901) 371-0609 7519 US Highway 64 38133 Garrett, Alexandra O DDS Goksel, Turker DDS Nichols-Gregory, Wendi DDS

Blaine

Cherokee Health Systems 0015074 (865) 933-4110 180 Emory Rd 37709 Monzon Benavides, Zinamong DDS

Bolivar

Bufford-Jones Family Dental Center 0014759 (731) 659-2885 407 W Lafayette St 38008 /H/ Bufford-Jones, Renita G DDS Parks, Anita J DDS

Bon Aqua

Johnson, Delilah DDS 0000145 (931) 670-4797 9584 Highway 46 37025 Brentwood

Coast Dental 0015659 (615) 661-7866 330 Franklin Rd, Ste 230 B 37027 Williams, Thomas C DDS

Cool Springs Family Dentistry * (615) 376-0011 7105 Bakers Bridge Ave # 400 37027 /H/ Bozeman, Andrew DDS Carter, Eric W DDS Hochhauser III, Edward DDS McNeely, Timothy J DDS

Chattanooga

Castle Dental Centers 0002812 (423) 894-3553 5708 Uptain Rd, Ste 100 37411 Andrews, Tena A Downer, Dean G DDS Wilkinson, Brian DDS Yates, Mitchell E DDS

Cowart, Mark S DDS 0000131 (423) 894-5258 4355 Highway 58, Ste 104 37416 Family Dental Practice 0000216 (423) 894-3490 4620 Highway 58 37416

Moulds Jr, Dan D DMD Hodges, Charles A DDS * (423) 875-0600 4224 Dayton Blvd 37415 Perry, Benjamin C DDS 0000276 (423) 893-7443 8703 E Brainerd Rd 37421 Woods, Elenora DDS 0000163 (423) 892-3545 6425 Bonny Oaks Dr 37416



Clarksville

Affiliated Dentists 0000218 (931) 647-6500 2057 Wilma Rudolph Blvd 37040 Kinney, John W DDS

Back To Basics Dental Center 0013181 (931) 645-8000 1762 Highway 48 37040 /B/H/ Biter, Jennifer J DDS Jones, Donald A DDS Nguyen, Nam T DDS Nguyen, Ngoc Dung T DDS Nichols, Ronald R DMD

Back to Basics Dental Center * (931) 648-4100 304 New Providence Blvd 37042 /H/ Biter, Jennifer J DDS Jones, Donald A DDS Nguyen, Nam T DDS Nguyen, Ngoc Dung T DDS Nichols, Ronald R DMD

St Bethlehem Dental Care * (931) 648-3233 2088 Lowes Dr, Ste C-D 37040 Carroccia, Anthony S DDS

Collierville

Collierville Family Dentistry * (901) 861-7007 2130 W Poplar Ave, Ste 106 38017 Ballard, Steve D DDS Kopko, Elena A DDS Ross, Grayson S DDS

Ploch, Thomas K DDS * (901) 854-1151 2028 W Poplar Ave, Ste 111 38017 Columbia

Hines, Morgan B DDS 0013427 (931) 388-3336 418 W 6th St 38401 Cookeville

Castle Dental Centers * (931) 528-2324 787B S Willow Ave 38501 Delaine, Charles Kimmons, Joseph L DDS Phillippi, William D DDS

Cordova

Cordova Family Dentistry * (901) 754-4383 8520 Macon Rd, Ste 1 38018 Calderon, Melissa DDS Wall Marks, Kathleen A DDS

Dental Practice 0015070 (901) 757-9596 1138 N Germantown Pkwy 38016 /H/ Tran, Ngoc H DDS

Garrett, Floyd DDS * (901) 737-8981 8089 Walnut Run Rd, Ste 3 38018 Henry Polk Dental Group DPC 0011214 (901) 755-0001 8110 Cordova Rd, Ste 125 38018

Polk-Workman, Erica DDS Smith, William M DDS * (901) 753-2273 1890 N Germantown Pkwy, #105 38018 Winbush, Sharifa H DDS 0016270 (901) 266-0555 2845 N Houston Levee Rd, #101 38016 /B/



Dickson

Anissa Burgess Family Dentistry 0014927 (615) 446-0681 1829 E Hwy 46 S 37055 /H/ Burgess, Anissa DDS

Dickson Dental * (615) 446-7050 1926 Highway 46 S 37055 /H/ Sigur, Shelley A DDS

Dyersburg

Reed, Ronald J DDS * (731) 286-0233 179 N Church Ave 38024 Estill Springs

ABC Family Dental * (931) 649-3238 802 N Main St 37330 /H/ Etter, Terry L DDS

Franklin

Castle Dental Centers 0000139 (615) 794-0402 1010 Murfreesboro Rd, # 196 37064 /H/ Curry, Shonna R DDS Downer, Dean G DDS Gordon, Alicia T DDS Knoel, Sara K DMD Lord, Gregory S DMD Mathis, Timothy R DMD

Coast Dental 0015641 (615) 599-0424 1113 Murfreesboro Rd, # 113 37064 Goksel, Turker DDS Lee, Jamie DDS

Palmer, Lee M DDS * (615) 794-0756 143 4th Ave N 37064 Gallatin

Oral Health Associates * (615) 451-3833 614 Commons Dr 37066 Kruger, Brian S DDS Miller, J. Andrew DDS Runyon, Rodney D DDS

Germantown

Kutas, Patrick W * (901) 754-2273 7512 Corporate Center Dr 38138 Goodlettsville

Castle Dental Centers 0000212 (615) 859-7900 813 Rivergate Pkwy 37072 Edmonds, Shanee DDS Gean, Rodney E DDS Humphrey Davis, Theryl DDS McNichols, Johnnie L DDS Vu, Rick Q DDS

Grady L Bryant DDS 0000148 (615) 859-3386 200 Rivergate Parkway 37072 Roberts, William D DDS

James L Bush DDS * (615) 851-6800 911 Meadowlark Ln 37072 Bush, James A DDS

Rivergate Dental 0000278 (615) 851-1777 919 Conference Dr, Ste 5 37072 Frazier, Roderick V DDS

Greenback

Elrod, James R DDS 0000077 (865) 856-2320 1761 Highway 95 S 37742



Greeneville

Ricker, Fred K DDS * (423) 639-3861 1719 Lafayette St 37745 Hartsville

Oral Health Associates * (615) 374-2684 118 McMurry Blvd 37074 Runyon, Rodney D DDS

Hendersonville

Embassy Dental Of Hendersonville 0015912 (615) 824-4833 177 W Main St 37075 Bozeman, Andrew DDS

Griffin, Daniel M DDS 0000074 (615) 822-4231 365 W Main St 37075 Hermitage

Affordable Dental of Tennessee 0016309 (615) 872-9269 5045 Old Hickory Blvd, # 102 37076 /B/H/ Ewing, Sabin K DMD Hall, Angel N DDS Humphrey Davis, Theryl DDS Lugakingira, Mulokozi K DMD Smiley, George W DDS

Hixson

Castle Dental Centers 0000187 (423) 875-9374 5756 Hwy 153, Ste C4-C5 37343 Edwards, Douglas R DDS

Jackson

Chatman, Sarah Minor DDS 0000186 (731) 424-8242 504 N Highland Ave 38301 Glenn, Clayton B * (731) 661-0051 20-C N Star Dr, C 38305 Jones II, O Chester DDS * (731) 664-6863 1869 US Highway 45 Byp 38305 Read, James D DDS 0000083 (731) 424-6452 1523 S Highland Ave 38301 Joelton

Mccammon, Gordon F DDS 0012532 (615) 876-0084 3515 Old Clarksville Pike 37080 Knoxville

Christenberry, Harry W DDS 0004683 (865) 525-0892 311 Concord St 37919 Decathlon Dental Group 0014291 (865) 694-8471 280 Ft Sanders W Blvd, #100 37922 /H/

Johns, Timothy Fulton DDS Dental Associates * (865) 539-6219 9111 Executive Park Dr, # D 37923

Massengale Jr, Lendell DMD Parkway Dental Office PC 0014052 (865) 690-5231 323 Fox Rd 37922 /H/

Hutcheson III, Philip T DDS Lovely, Dan G DDS Prout, Franklin J DDS

Showalter, W Nicholas DDS 0000114 (865) 588-5761 6322 Papermill Dr 37919 Thompson, Dan H DDS 0000061 (865) 691-1121 200 Ft Sanders W Blvd, #301 37922 Waddell, Reggie M DDS * (865) 922-7471 3629 Neal Dr 37918 La Vergne

Odds Dental * (615) 793-1242 331 Waldron Rd 37086 /H/ Odds, Marvo C DDS



Lebanon

Montgomery, Herman DDS 0000301 (615) 453-9937 701 Park Ave 37087 Moore, E Darryl DDS 0000043 (615) 449-4503 1314 W Main St 37087 Lenoir City

Hendricks, Ronald A DDS * (865) 986-3514 200 N A St 37771 Lewisburg

Tri Counties Dental Center 0000019 (931) 359-1993 1360 S Ellington Pkwy 37091 Thomas, Larry D DDS

Winchell, Wesley A DDS 0000057 (931) 359-2278 1141 Nashville Hwy 37091

Lexington

Clampitt, Robert H DDS * (731) 968-2796 136 N Main St 38351 Madison

Briley Parkway Dental Center 0011067 (615) 870-5788 1208 S Graycroft Ave 37115 Williams, Valerie L DDS

Dental Plus LLC 0014598 (615) 865-4449 1570 Gallatin Pike N 37115 Hunter, Tania L DDS

Dental Wellness Center 0000242 (615) 777-1411 913 Gallatin Rd S 37115 Doherty, S Adele DDS

Southeastern Dental Group 0000130 (615) 868-6177 117 N Gallatin Rd 37115 Foster, Darren G DDS Kolodziejski, Mark V DDS Miller, J. Andrew DDS Taylor, Floyd R DDS

Susan Kim Family Dentistry * (615) 612-1740 500 Lentz Rd, Ste 60 37115 /B/ Kim, Sook Ja DDS

Mc Ewen

McEwen Dental Assoc. 0015835 (931) 582-6997 161 Railroad St 37101 /H/ Davis, William P DDS Krug, Ari Y DMD Lugakingira, Mulokozi K DMD

Memphis

Adams Browne Dental Associates 0000123 (901) 332-7111 3333 Elvis Presley Blvd, # 202 38116 Adams-Browne, Kaye Yvonne DDS

Braxton, Sonia D DDS 0013170 (901) 775-0870 1154 S Bellevue Blvd 38106 /H/ Centennial Village Dental Group PC * (901) 752-1290 7825 Winchester Rd, Ste 115 38125

Carrier, Thomas W DDS Jasper, William S DDS Williams, Ben R DDS

Chelsea Dental 0000067 (901) 458-1118 2410 Chelsea Ave 38108 Pryor, Gloria J DDS

Perfect Smile Dentistry 0011818 (901) 763-3601 4646 Poplar Ave, Ste 514 38117 Cheryl A Jackson

Chinn Jr, Harry J DDS * (901) 365-2866 6622 Kirby Center Cv 38115



Cooper Street Dental 0000166 (901) 276-5822 1032 S Cooper St 38104

Pryor, Gloria J DDS Winbush, Sharifa H DDS

Dewitt King DDS 0000039 (901) 743-2055 2212 Airways Blvd 38114 Thomas, J Douglas DDS

Dove, Laura B DDS 0000171 (901) 373-3800 7189 Stage Rd 38133 Hedgerow Family Dentistry 0011900 (901) 363-3144 6757 E Shelby Dr 38141

Christion, Tracey D DDS Herring, Larry W DDS * (901) 452-3211 183 Tillman St 38111 Hickory Hill Family Dental 0000231 (901) 797-3077 3725 Riverdale Rd, Ext 1 38115

Myers, Lee T DDS

Hudson III, Roy A DDS 0000247 (901) 526-4442 516 Vance Ave 38126 Jeu, Richard C DDS 0000220 (901) 774-9602 1799 3rd St 38109 Johnson Jr, Joseph DMD * (901) 346-3257 4299 Elvis Presley Blvd 38116 Kirk, Cleo DDS 0000133 (901) 743-5723 2523 Lamar Ave 38114 Kutas, Timothy W DDS 0000194 (901) 327-5604 515 N Highland St, Ste C 38122 Larry D Sims & Associates * (901) 725-1884 1279 Lamar Ave 38104 Meadows, Jeffrey R DDS 0015297 (901) 767-0507 4700 Poplar Ave, Ste 410 38117 Modhvadia, V M DDS 0000018 (901) 353-2424 3122 Thomas St 38127 Myers, Lee T DDS 0000159 (901) 276-4629 1952 Lamar Ave 38114 New Image Family Dentistry 0012042 (901) 366-9953 2713 Mount Moriah Rd, # 101 38115

Anderson, Tonya Lyons DDS New Image Family Dentistry Riverdale

0015445 (901) 365-2000 3719 Riverdale 38115 /H/

Anderson, Tonya Lyons DDS Oak Court Dental Clinic 0000157 (901) 680-9578 4515 Poplar Ave, Ste 227 38117

Leordeanu, Michaela DDS Parkway Village Family Dentistry 0000008 (901) 566-1414 3037 S Perkins Rd 38118

Christian, Solomon DDS Payne Family Dentistry 0012889 (901) 365-9054 3574 Hickory Hill Rd 38115

Jackson, Payne L DDS Jackson-Payne, Adrienne M DDS

Raleigh Family Dentistry * (901) 386-2328 3068 Covington Pike, Ste 2 38128 Calderon, Melissa DDS Dodd, Russell M DDS Hochhauser III, Edward DDS Ward, Michelle E DDS

Schmidt, Bryan DDS * (901) 523-8614 100 N Main St, Ste 3218 38103 Smile Studios of Memphis 0011068 (901) 346-1820 1697 Bender Rd 38116

Alexander, Carlos D DDS Southwind Family Dentistry * (901) 624-0440 7948 Winchester Rd, Ste 108 38125

Hochhauser III, Edward DDS Holmes, Kurt M DDS



Spell III, Charlie DDS 0000175 (901) 794-3391 6223 Mount Moriah Rd Ext 38115 Spell III, Charlie DDS 0000207 (901) 362-7844 4137 Kirby Pkwy, Ste 3 38115 Spell III, Charlie DDS 0000249 (901) 357-0797 3697 North Watkins Street 38127 Sykes, O T DDS 0000183 (901) 323-7613 1399 Airways Blvd, Ste 6 38114 Thomas, J Douglas DDS * (901) 377-5060 6630 Summer Knoll Cir 38134 Union Ave Dental Association 0010593 (901) 276-7314 1331 Union Ave, Ste 1225 38104

ONeal, Joe DDS Polk-Workman, Erica DDS Spell III, Charlie DDS

Uptown Dental Center LLC 0014457 (901) 527-2101 493 N Front St, Ste 101 38105 /H/ Branch, Joerald D DDS

Villamil, Wanda E DMD 0012453 (901) 385-2853 4325 Stage Rd, Ste 2 38128 /B/

Vincent J Price & Associates 0000012 (901) 332-8729 1440 E Shelby Dr, Ste 5 38116 Morris, Keith D DDS Thomas, Marrio R

Vincent J Price DDS 0000245 (901) 755-7392 2900 Kirby Rd, Ste 9 38119 Morris, Keith D DDS

William F Smith DDS 0000096 (901) 767-1610 5100 Wheelis Dr, Ste 214 38117 Rutledge, Joel W DDS

Worrell, Leroy A DDS 0000232 (901) 526-7177 5359 Knight Arnold Rd 38115 Mt. Juliet

Cordice, Norman H DDS 0012264 (615) 754-8890 2510 North Juliet Rd 37122 /H/ Murfreesboro

Castle Dental Centers 0010659 (615) 867-6360 790 NW Broad St 37129 Carrion, Claudette T DMD Gordon, Alicia T DDS Ward, Amy N DDS

Coast Dental 0015638 (615) 890-1811 1760 W Northfield Blvd 37129 /H/ Minyard, Ryan E DDS

Melanie D Dunson DDS Family Dental

* (615) 896-0580 810 Nw Broad St 37129

Perry Family Dentistry LLC * (615) 896-3360 1121 Greenland Dr 37130 Hill, William F DDS Perry, Aldrich T DDS

Nashville

108 Dental Group 0000053 (615) 352-8696 108 Harding Pl, Ste 202 37205 Calway Fagen, Norman J DDS

Acme Care Dental 0000107 (615) 226-7516 3067 Brick Church Pike 37207 Felder Jr, Harry DDS Williams, Valerie L DDS

All Care Dentistry 0011977 (615) 385-9744 808 Kirkwood Ave 37204 /H/ Pate, James E DDS



Aqua Dental 0016188 (615) 331-1111 5630 Nolensville 37211

Collins, Edwina K DDS Turner, Sandra L DDS

Belleview Coast Dental 0015640 (615) 673-7627 7095 Highway 70 S, Ste DD 37221 Gray II, Phillip DDS

Brannon & Williams DDS 0000129 (615) 269-5617 1900 12th Ave S 37203 Brannon, Thomas E DDS Williams, Robert A DDS

Brewster, Jasper B DDS 0002751 (615) 320-0662 1700 Dr DBy Todd Jr Blvd 37208 Burgess, Anissa DDS 0012242 (615) 244-5264 3803 Hydes Ferry Rd, Ste A 37208 /H/ Byron V Bush DDS 0000154 (615) 385-9400 625 Berry Rd 37204

Gray II, Phillip DDS Gray, Julie A DDS

Cason Dental Center * (615) 232-2221 2828 Elm Hill Pike, Ste 105 37214 /B/H/ Cason, Terrence L

Castle Dental Centers 0000160 (615) 352-5894 28 White Bridge Rd, Ste 108 37205 Meade, Columbia L DDS Minyard, Ryan E DDS

Castle Dental Centers 0000263 (615) 361-3130 2375 Murfreesboro Pike, # 101 37212 Daniels, Jacqulyn D DDS

Castle Dental Centers 0000267 (615) 837-4331 3907 Nolensville Pike 37211 /H/ Breaux, Johnnie DDS Cannon, Benjamin H DDS Griffin, Jonathan David DDS Humphrey Davis, Theryl DDS Lumpkin Jones, Lori DDS Smith, Bobbi L DDS Yagobi, Anthony DDS

Coast Dental 0015639 (615) 316-0701 3189 Lebanon Pike 37214 Gray, Julie A DDS Roberts, Anitra M DDS

Dr Davis Dudley Family Dentistry 0015954 (615) 299-8700 3915 Clarksville Pike, Ste B 37218 /H/ Davis Dudley, DeRanae R DDS

Family Dentistry 0011532 (615) 327-2681 2108 Meharry Blvd 37208 Presley, Oliver W DDS

Farmer - Dixon, Cherae M DDS 0013004 (615) 244-5265 1005 Dr DB Todd Jr Blvd, #336 37208 Farmer - Dixon, Cherae M DDS 0000125 (615) 244-5264 3803 N Hydes Ferry Rd 37218 Farmer - Dixon, Cherae M DDS 0013120 (615) 532-2043 3965 Stewarts Ln 37218 /H/ Felix, Dudley E DDS 0000164 (615) 329-9797 1500 Charlotte Ave 37203 Five Star Dental 0015098 (615) 226-8434 3314 Gallatin Rd 37216

Woods, Donald DDS Five Star Dental Care 0000128 (615) 226-8434 3314 Gallatin Rd, Box 284 37216

Turner, Sandra L DDS Turner, Sandra L DDS

Forster, Teri D DDS * (615) 341-0037 1915 Church St, Ste 3 37203 /H/



Fussell, James E DDS 0000104 (615) 646-5595 7648 Highway 70 S 37221 Guinn, Roney Otis W DDS 0000050 (615) 298-2488 4300 Charlotte Ave 37209 Heavenly Images Dental & Nutritional Center PLLC

0015613 (615) 783-0142 2802 Bransford Ave 37204

Harris, Ethel P DDS Home Bound Dentistry 0011533 (615) 327-6946 1005 Dr. Tood Jr., Suite 540 37208

Doherty, S Adele DDS Jackson, Benita DDS 0000290 (615) 256-2321 617 Woodlands Street 37206 Jolly, Bradley E DDS 0014403 (615) 383-0670 2200 21st Ave S, Ste 302 37212 Larry, Bobby DDS 0000205 (615) 329-0008 2011 Charlotte Ave 37203 Latimer, Harvey DDS 0000014 (615) 320-1805 1900 Patterson St 37203 Martin Dental 0016359 (615) 327-4499 908 34th Ave N 37209 /B/H/

Moore, Brenda L DDS Mason, William DDS 0000022 (615) 831-1966 183 Thompson Ln 37211

Matthew Walker Health Center 0010308 (615) 327-9400 1035 14th Avenue North 37208 Brewster, Jasper B DDS Humphrey Davis, Theryl DDS Waldon III, Thomas G DDS Worthy, Artmas L DDS

Medwedeff, Fred M DDS 0000054 (615) 327-4244 121 21st Ave N 37203 Metro Dental 0010582 (615) 254-8608 1314 5th Ave N, Ste 400 37208

Engtow, Eugene T DDS Owens, Walter R DDS 0000102 (615) 256-2321 617 Woodland St 37206 Premier Dental 0016444 (615) 837-8855 5511 Edmondson Pike, #201 37211 /H/

Williams, Thomas C DDS Presley, Oliver W DDS 0000238 (615) 327-2681 2108 Meharry Blvd 37208 Scales II, William D DDS 0004680 (615) 244-5264 3803 Hydes Ferry Pike 37218 Shaikh, Khalid N DDS 0000101 (615) 352-5582 6202 Charlotte Pike 37209 Shulman, Stephen R DDS * (615) 383-4494 4219 Hillsboro Pike 37215 Smiley Dental Associates Inc 0016534 (615) 321-5600 343 22nd Ave N 37203

Smiley, George W DDS Suttles, Joseph C DDS 0000162 (615) 320-5804 121 21st Ave N, Ste 202 37203 Thomason, Michael J DDS * (615) 329-4388 346 21st Ave N 37203 Two Rivers Dental 0012369 (615) 889-9777 113 Graylynn Dr 37214 /B/

Burgess, Miguel A DDS West End Smiles PLC * (615) 327-4903 109 29th Ave N 37203

Hrstic, Ivana K DDS Williams, Eric M DDS 0000294 (615) 837-4525 197 E Thompson Ln 37211 Worthy, Artmas L DDS 0002761 (615) 320-0662 1700 Dr Db Todd Jr Blvd 37208 New Tazewell

Donesky, Melvin K DDS 0002726 (423) 626-6565 PO Box 684 37824 Oakland

Smith, Johnny Sheldon DDS * (901) 466-1580 7066 US Highway 64 38060 Pleasant View

Latimer, Harvey DDS 0011064 (615) 320-1805 6522 Hwy 41 A 37146



Seymour

American Family Dentisry of Seymour

* (865) 579-5010 11618 Chapman Hwy, Ste B 37865

Carney, Charles T DDS Smyrna

Alissandratos, George L DDS 0013426 (615) 459-4474 431 Nissan Dr, Ste 202 37167 Integrity Dental Care PLLC 0014942 (615) 220-5533 301 Wolverine Trail, Ste 203 37167 /H/

Mitchell, Jacqueline B DDS Somerville

Richardson Family Dentistry 0015834 (901) 466-9833 17395 Hwy 64 East 38068 /B/ Richardson, Dwayne DDS

Sparta

Pratt, Larry J DDS 0010398 (931) 836-8182 223 N Spring St 38583

Springfield

Affordable Dental of Tennessee 0016294 (615) 382-0700 314 Northcrest Dr 37172 /B/H/ Ewing, Sabin K DMD Hall, Angel N DDS Humphrey Davis, Theryl DDS Lugakingira, Mulokozi K DMD Smiley, George W DDS

Coleman, Helen L DDS 0000155 (615) 384-2858 113 5th Ave W 37172 Stanton

Dr C R White & Assoc. Dental Center Inc

* (731) 548-2400 17 First St E 38069

Tazewell

Stapleton, Roy S DMD 0000044 (423) 626-8289 1839 Main St 37879 Tullahoma

Castle Dental Centers 0000201 (931) 455-0950 2111 N Jackson St, Ste 9 37388 Locke, Franklin Graham DDS Sikes, Kimberly DDS Ward, Amy N DDS

KENTUCKY Middlesboro

Cordell W Tolliver DMD 0012186 (606) 248-5302 714 Exeter Ave 40965

MISSOURI Saint Peters

James G Evans DDS 0001907 (636) 441-7440 1400 Triad Center Dr 63376

PARTICIPATING SPECIALIST DIRECTORY STATE OF TENNESSEE as of August 09, 2006 This directory is subject to change. To verify a Provider’s continued participation or receive the most current listing of Participating Providers call 800.443.2995 Monday – Friday 7 am – 6 pm (CST) or visit our website at www.assurantemployeebenefits.com. City Special Provider/Dentist Phone Address Services


Endodontist Chattanooga

Berlin, Joel W DDS (423) 894-5764 6918 Shallowford Rd, Ste 100 37421 Crossville

Berlin, Joel W DDS (931) 707-0943 815 Webb Ave, Ste 104 38555

Hermitage

Jimmy B Sheats DDS (615) 885-0184 4243 Lebanon Rd, Ste B 37076 Sheats, Jan Nee B DDS

Knoxville

Hughart, Donald Wayne DDS (865) 692-2380 121 S David Ln 37922 /S/ Murfreesboro

Sheats Endodontic Group (615) 216-1350 1826 Ward Dr, Ste 203 37129 /H/ Sheats, Jan Nee B DDS Sheats, Jimmy B DDS

Nashville

Jimmy B Sheats DDS (615) 320-0099 1915 Charlotte Ave, Ste 205 37203 Sheats, Jan Nee B DDS

Oral Surgeon Athens

East Tenn Oral & Maxillofacial Surgery (865) 524-3646 307 Maple St 37303 Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS

East Tenn Oral & Maxillofacial Surgery (423) 745-8708 719 Cook Dr, Ste 114 37303 Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS

Foothills Oral and Maxillofacial Surgery PC (423) 744-8500 719 Cook Dr, Ste 114 37303 Gross, Kevin D DDS Gross, Paul Dwayne DDS

Barlett

Raleigh Bartlett Oral Surgery (901) 386-6385 2785 Summer Oaks Dr, #101 38134 /S/ Cannon, John S DDS McRae, Joseph L DDS Wilson, Gary T DDS

Brentwood

Embassy Dental Brentwood (615) 661-7866 330 Franklin Rd, Ste 230 B 37027 /S/ Carter, Jeffrey B DMD

Chattanooga

Chattanooga Oral & Maxillofacial Surgery PLC (423) 296-8905 1720 Gunbarrel Rd, Ste 200 37421 /H/S/ McDonald, David Patrick DMD



Dickson

Dickson Jaw and Facial Surgery (615) 441-1441 445 Henslee Dr 37055 Savell, Truitt A DDS

Oral Surgical Institute (615) 446-2598 311 E College St 37055

Carter, Jeffrey B DMD

Stonecrest Oral & Maxillofacial Surgery (615) 223-1200 1926 Hwy 46 South 37055 /H/ Gordon Maloney, Jennifer L DDS

Fairfield Glade

Rivers, J Benjamin DMD (931) 456-0232 5655 Peavine Rd, Ste 102 38571 /S/ Franklin

Embassy Dental Franklin (615) 599-0424 1113 Murfreesboro Rd 37064 /S/ Carter, Jeffrey B DMD

Franklin Oral Surgery (615) 599-9606 101 Holiday Ct 37067 Lawrence, Felix R DDS

Oral Surgical Institute (615) 778-0902 2000 Mallory Ln, Ste 620 37067 /B/S/ Carter, Jeffrey B DMD

Urbanek, Anthony P DDS (615) 771-1983 1909 Mallory Ln, Ste 100 37067 /S/ Gainesboro

Dental Specialty Group (615) 832-6460 205 S Union St 38562 /B/S/ Nkungula Howlett, Tania C DDS

Gallatin

Burchfield Richardson & McLeod (615) 451-0015 355A Hancock St 37066 Burchfield, Daniel C DMD Mcleod, Bruce C DDS Richardson, Greg DMD Shea, John K DMD Thompson, Thomas M DMD

Goodlettsville

Burchfield Richardson & McLeod (615) 859-0015 307 Bluebird Dr 37072 Burchfield, Daniel C DMD Mcleod, Bruce C DDS Richardson, Greg DMD Shea, John K DMD Thompson, Thomas M DMD

Hendersonville

Burchfield Richardson & McLeod (615) 822-8403 131 Indian Lake Blvd, Ste 100 37075 Burchfield, Daniel C DMD Mcleod, Bruce C DDS Richardson, Greg DMD Shea, John K DMD Thompson, Thomas M DMD

Embassy Dental Hendersonville (615) 824-4833 177 W Main St 37075 /S/ Carter, Jeffrey B DMD



Hermitage

Oral Surgical Institute (615) 872-9186 5045 Old Hickory Blvd, #102 37076 Carter, Jeffrey B DMD

Knoxville Carroll R Shanks DDS PC (865) 531-5995 241 N Peters Rd 37923 /S/

Shanks, Charles H DDS

East Tenn Oral & Maxillofacial Surgery (865) 688-0410 2939 Essary Dr, Ste1 37918 Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS

East Tenn Oral & Maxillofacial Surgery (865) 531-3909 200 Ft Sanders W Blvd, #105 37922 Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS

High, William R DMD (865) 691-0918 248 N Peters Rd 37923 Hudson, John W DDS (865) 544-9021 1930 Alcoa Hwy, Ste 335 37920 Jordan Oral Surgery (865) 588-9589 109 Northshore Dr, Ste 404 37919

Jordan, Robert D Read, Daniel S DDS (865) 291-1520 111 Fox Rd, Ste 201B 37922 Rivers, J Benjamin DMD (865) 690-5691 6906 Kingston Pike, Ste 205 37919 Shanks, Carroll R DDS (865) 977-8048 1924 Alcoa Hwy 37920 Timothy P McConnell DDS (865) 977-7110 1930 Alcoa Hwy, Ste 335 37920

Napier, Troy Randell DMD Slater, Otto W DDS

Timothy P McConnell DDS (865) 577-8736 1924 Alcoa Hwy, Ste 335 37920 Slater, Otto W DDS

Lenoir City East Tenn Oral & Maxillofacial Surgery (865) 986-4582 603 Highway 321 N, Unit 20 37771

Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS

Foothills Oral and Maxillofacial Surgery PC (865) 986-4582 603 Hwy 321 N, Bldg 4 #20 37771 Gross, Kevin D DDS Gross, Paul Dwayne DDS

Madison Rivergate Medical Center (615) 859-3344 85 Cude Ln 37115

Peeples, Harold C DDS Maryville Carroll R Shanks DDS (865) 977-8048 1511 W Lamar Alexander Pkwy 37804 /S/

Shanks, Charles H DDS East Tenn Oral & Maxillofacial Surgery (865) 983-8630 1505 E Lamar Alexander Pkwy 37804

Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS



Timothy P McConnell DDS (865) 977-7110 1858 Crest Road 37804 /S/

Napier, Troy Randell DMD Slater, Otto W DDS

Memphis

Cannon Sexton Oral Maxillofacial Surgery (901) 756-8475 1717 Kirby Pkwy 38120 /B/ Cannon, John S DDS Sexton, Stephen Barrett DDS

Center for Oral & Facial Surgery of Memphis (901) 398-0793 2900 Kirby Rd, Ste 10 38119 /H/S/ Meekins, Richard D DDS Staples, Ronald Carlton

Center for Oral & Facial Surgery of Memphis (901) 398-0793 1251 Wesley Dr, Ste 101 38116 Staples, Ronald DDS Williams, Michael A

Fordjour, Isaac DDS (901) 526-3988 910 Madison Ave, Ste 710 38105 /S/ J E Albright DDS (901) 685-8090 766 S White Station Rd 38117 /S/

Peck, Russell C DDS McRae Wilson Oral Surgery (901) 767-0088 5565 Murray Rd 38119

McRae, Joseph L DDS Wilson, Gary T DDS

Raleigh Bartlett Oral Surgery (901) 756-8475 1717 Kirby Pkwy 38120 Cannon, John S DDS

Stein, Gilbert G DDS (901) 755-1177 1715 Kirby Pkwy, Ste 101 38120 /S/ Zelig, David DDS (901) 767-7741 5575 Poplar Ave, Ste 512 38119 Murfreesboro

Dream Team Oral Surgery (615) 216-0360 1810 Ward Dr, Ste 101 37129 /H/ Bratton, Terrance A DDS Daniel, Robin R DDS

Embassy Dental Murfreesboro (615) 890-1811 1760 W Northfield Blvd 37129 /S/ Carter, Jeffrey B DMD

Nashville

Bennett, C Ray DDS (615) 321-4070 1005 Dr Db Todd Jr Blvd 37208 Boyd, Scott B DDS (615) 343-9402 1301 22nd Ave S, Ste1623 37232 /S/ Brod, Robert DDS (615) 834-4990 397 Wallace Rd, Ste 207 37211 /S/ Dental Specialty Group Inc (615) 832-6460 390 Harding Pl, Ste 101 37211

Howlett, Brian K DDS Nkungula Howlett, Tania C DDS

Embassy Dental Bellevue (615) 673-7627 7095 Highway 70 S, Ste DD 37221 /S/ Carter, Jeffrey B DMD

Embassy Dental Donelson (615) 316-0701 3189 Lebanon Pike, Ste 10 37214 /S/ Carter, Jeffrey B DMD

Jackson, D Carl DDS (615) 256-2321 617 Woodland St 37206 /B/S/ Jackson, D Carl DDS (615) 327-2494 1801 Church St 37203 /B/S/ McKenna, Samuel J DDS (615) 343-9402 1623 The Vanderbilt Clinic, 37232 /S/



Oral & Facial Health Center (615) 327-3534 2400 Patterson St, Ste316 37203

Albury Jr, Charles D DMD Oral & Maxillofacial Surgery (615) 327-9944 1916 Patterson St, Ste 710 37203 /S/

Daniel, Robin R DDS Oral Surgical Institute (615) 329-4401 324 22nd Ave N 37203 /S/

Carter, Jeffrey B DMD Hall, Hugh D DMD

Vanderbilt Medical Group (615) 322-3000 3601 The Vanderbilt Clinic 37232 Reddi, Sanjay P DDS

Williams Jr, Charles W DDS (615) 327-6370 1005 D B Todd, Ste 309 37208 Oak Ridge

East Tennessee Oral & Maxillofacial Surgery (865) 482-2600 700 S Illinois Ave, Bldg A #104 37830 Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS

Sevierville

East Tenn Oral & Maxillofacial Surgery (865) 453-1070 1112 Medical Park Court 37862 Mann Jr, James H DDS Widloski, Mark M DDS Witt, Wayne R DDS

Seymour

Seymour Family Dentistry (865) 577-7800 111 Peacock Ct 37865 McConnell, Timothy P DDS Napier, Troy Randell DMD Slater, Otto W DDS

Smyrna

OMS Specialists PLLC (615) 220-5525 980 Mayfield Drive 37167 /S/ Doctora, Joseph S DDS

Spring Hill

OMS Specialists PLLC (931) 302-3383 5226 Columbia Hwy, Ste 7 37174 /B/S/ Doctora, Joseph S DDS

Springfield

Burchfield Richardson & McLeod (615) 384-0015 2104B Park Plaza Dr 37172 Burchfield, Daniel C DMD Mcleod, Bruce C DDS Richardson, Greg DMD Shea, John K DMD Thompson, Thomas M DMD

Jackson, D Carl DDS (615) 384-2858 113 5th Avenue W 37172 /B/H/S/ Oral Surgical Institute (615) 384-1104 314 Northcrest Dr 37172

Carter, Jeffrey B DMD



Orthodontist Chattanooga

Flanagan, Don F DDS (423) 855-4201 7003 Shallowford Rd 37421 Hodges, Jill P DDS MS (423) 843-1880 5470 B Hixon Pike 37343 Clarksville

Middle Tennessee Orthodontic Speci (931) 647-7900 1154A Fort Campbell Blvd 37042 Wyatt, David L DMD

Cleveland

Flanagan, Don F DDS (423) 559-0887 2372 N Ocoee St 37311 Cookeville

Koen, Tommy J DMD (931) 526-1131 1195 E Spring St 38501

Hendersonville

Cohen, Gary D DDS (615) 824-8929 133 Indian Lake Rd 37075 Koen, Tommy J DMD (615) 824-5636 131 Indian Lake Blvd 37075 Hermitage

Benson, Bartley H DDS (615) 885-1349 4243 Lebanon Pike, Ste C 37076 Hixson

Tennessee Valley Orthodontics (423) 877-1286 1000 Ring Road, Ste 103 37343 Flanagan, Don F DDS

Knoxville

Diddle, John A DDS (865) 693-6561 248 N Peters Rd 37923 Diddle, John A DDS (865) 675-3900 135 W End Ave 37922 Parker, Marshall DDS (865) 584-3924 111 S Weisgarber Rd 37919 /B/ Parker, Marshall DDS (865) 539-0056 280 Ft Sanders W, Ste 114 37922 /B/ Madison

Jackson, Elbert E DDS (615) 859-1881 200 Gleaves St, Ste C 37115 Middle Tennesse Orthodontic Specia (615) 859-2700 2105 Gallatin Rd N 37115

Wyatt, David L DMD Memphis

Tri State Orthodontic Specialists (901) 937-7797 7970 Giacosa Pl, Ste 104 38133 Watts, Samuel L DDS

Watts, Samuel L DDS (901) 767-6320 5101 Sanderlin Ave, Ste 108 38117 Murfreesboro

Jones, Robert H DDS (615) 893-1629 540 Highland Ter 37130 Nashville

American Family Orthodontics (615) 399-7220 2292 Murfreesboro Pike 37217 Jackson, Elbert E DDS

Cohen, Gary D DDS (615) 292-8990 2505 21st Ave S 37212 Legan, Harry L DDS (615) 343-0633 1500 21st Ave S, Ste 3400 37212 Oliver, Stephen V DDS (615) 321-4404 1808 W End Ave, Ste 105 37203 Vanderbilt Medical Group (615) 322-3000 3601 The Vanderbilt Clinic 37232

Ballard, Richard Aaron DDS Conley, Richard S DMD



Young Jr, Donald L DDS (615) 321-1347 110 30th Ave S, Ste 100 37212 Smyrna

Ewing Orthodontics (615) 220-8585 739 President Pl, Ste 210 37167 /H/ Ewing, Sabin K DDS

Springfield

Koen, Tommy J DMD (615) 384-1155 2104 Park Plaza Dr 37172 White House

Cohen, Gary D DDS (615) 824-8929 614C Highway 76 37188 Koen, Tommy J DMD (615) 672-3774 2823 Highway 31 W 37188

Pedodontist Cordova Cohen, Alka V DDS (901) 756-4447 8142 Country Village Dr, #101 38018 Franklin Snodgrass King Pediatric Dental Associates (615) 771-1111 4085 Mallory Ln, Ste 200 37067 /B/H/

King, John T DMD Snodgrass, David J DDS

Hendersonville Templeton, Angela L DDS (615) 826-9259 557-A Johnny Cash Parkway 37075 Hermitage David J Snodgrass DDS (615) 885-3525 4761 Andrew Jackson Pkwy 37076

King, John T DMD Knoxville Bell, J William DDS (865) 687-4450 2931 Essary Dr 37918 Nashville June Owens DDS (615) 327-0322 2011 Charlotte Ave 37203

Hines, Edwin H DDS Smiley, Kim A DDS (615) 321-5600 343 22nd Ave N 37203

Periodontist Athens Bauguss Jr, Jack T DDS (423) 744-7723 107 Park St 37303 /S/ Knoxville

Adkins, Danny DDS (865) 588-8539 1301 Old Weisgarber Rd 37909 Bauguss Jr, Jack T DDS (865) 588-5778 6311 Kingston Pike, Ste 6-W 37919 Hovious, Lee Ann DMD (865) 539-1113 10265 Kingston Pike, Ste B 37922 Hovious, Lee Ann DMD (865) 539-1113 3221 John Sevier Hwy N 37920 /S/ Maryville

Bauguss Jr, Jack T DDS (865) 982-7454 327 W Broadway Ave 37801 /S/ Memphis

Martin, Denise M DDS (901) 276-6000 1286 Peabody Ave 38104 /S/

Nashville

Periodontal & Implant Assoc of Middle TN (615) 297-8973 4219 Hillsborough Pike, #107 37215 Pulliam, Robert P DMD



Oak Ridge

Adkins, Danny DDS (423) 482-7355 400 Laboratory Rd, Ste 102 37830

Prosthodontist Nashville

Associated Prosthodontics (615) 297-5577 2828 Bransford Ave 37204 Lubovich, Ronald P DDS

KENTUCKY

Oral Surgeon Bowling Green

Burchfield Richardson & Mcleod (502) 783-0064 1848 Lyda Ave 42104 /S/ Burchfield, Daniel C DMD Mcleod, Bruce C DDS Richardson, Greg DMD Thompson, Thomas M DMD

MISSOURI

Orthodontist Saint Peters

Family Dental Services (636) 397-5984 7020 Mexico Rd 63376 Muddasani, Padmini R DDS

Products are marketed by Assurant Employee Benefits, andare underwritten and/or provided by Union SecurityInsurance Company.

State of Tennessee Prepaid PlanPlease Print

Name __________________________________________________LAST FIRST MIDDLE INITIAL

Social Security Number __________________________________Dentist Facility Number ____________________________________ Date___________Phone Number___________________________________________________________________________Employee Signature ______________________________________

If eligible Family Members have a different dentist selection from yours, listthe information below:

First Name MI Last Name (if different) Dentist Facility ID#

Employees enrolling for dental coverage must return this card and a completed Stateof Tennessee enrollment/change application to their agency’s insurance preparer.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dentist Selection Card How do I join the PrepaidPlan?1. Complete the appropriate sections of

the State of Tennessee enrollment/change application and return it toyour agency’s insurance preparer. (Ifyou need a copy of this application,please contact your agency’sinsurance preparer.)

2. Select a General Dentist for yourselfand every eligible member of yourfamily. (A list of General Dentistsparticipating with the Prepaid Plan isincluded in this booklet or, you mayselect a participating dentist online atwww.assurantemployeebenefits.comfrom the DentiCare providerinformation.

3. Complete the Dentist Selection Cardat left, being sure to include the 7-digit Dental Facility ID# for eachParticipating General Dentist youselect. (A list of General Dentistsparticipating with the Prepaid Plan isincluded in this booklet.) Detach andreturn the card directly to youragency’s insurance preparer.

cut along dotted line

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KC3181 (9/2006)

3595 Grandview Parkway, Suite #650Birmingham, AL 35243

If you need more information, please call Customer Service at 800.443.2995 or visit us at

www.assurantemployeebenefits.com

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