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DENTAL<br />

DIRECTORY


CONNECTION <strong>Dental</strong> Network<br />

Table of Contents<br />

Adams County ..................................................................................................3<br />

Allamakee County .............................................................................................3<br />

Audubon County ...............................................................................................3<br />

Benton County ..................................................................................................3<br />

Black Hawk County...........................................................................................3<br />

Bremer County .................................................................................................3<br />

Carroll County ..................................................................................................3<br />

Cass County ......................................................................................................3<br />

Cerro Gordo County .........................................................................................3<br />

Clayton County .................................................................................................3<br />

Dallas County ...................................................................................................3<br />

Decatur County .................................................................................................3<br />

Des Moines County ............................................................................................3<br />

Dickinson County ..............................................................................................3<br />

Dubuque County ...............................................................................................3<br />

Fayette County ..................................................................................................3<br />

Floyd County ....................................................................................................3<br />

Greene County ..................................................................................................3<br />

Hardin County ..................................................................................................3<br />

Harrison County ...............................................................................................3<br />

Jones County ....................................................................................................4<br />

Linn County......................................................................................................4<br />

Mills County .....................................................................................................4<br />

Mitchell County ................................................................................................4<br />

O'Brien County .................................................................................................4<br />

Osceola County .................................................................................................4<br />

This directory of providers may change from time to time for any number of reasons. Such changes may sometimes<br />

occur before a new directory can be printed. CONNECTION <strong>Dental</strong> does not guarantee the continued participation of<br />

the providers listed or that participating providers are available in all areas. Please refer to your benefit booklet for a<br />

complete description of your plan's coverage, limits, and exclusions.


Table of Contents<br />

Polk County ......................................................................................................4<br />

Pottawattamie County .......................................................................................4<br />

Scott County .....................................................................................................4<br />

Tama County ....................................................................................................5<br />

Taylor County ...................................................................................................5<br />

Union County....................................................................................................5<br />

Warren County .................................................................................................5<br />

Woodbury County .............................................................................................5<br />

Index of <strong>Participating</strong> <strong>Dentists</strong> ..............................................................................7<br />

Provider Nomination Form ....................................................................................9<br />

This directory of providers may change from time to time for any number of reasons. Such changes may sometimes<br />

occur before a new directory can be printed. CONNECTION <strong>Dental</strong> does not guarantee the continued participation of<br />

the providers listed or that participating providers are available in all areas. Please refer to your benefit booklet for a<br />

complete description of your plan's coverage, limits, and exclusions.


Adams County<br />

ADAMS COUNTY<br />

General Dentistry<br />

King, John T DDS<br />

504 8th St<br />

Corning, IA 50841<br />

(515) 322-3146<br />

ALLAMAKEE<br />

COUNTY<br />

General Dentistry<br />

Carlson, Bruce A DDS<br />

267 Main St<br />

Lansing, IA 52151<br />

(563) 538-4673<br />

AUDUBON<br />

COUNTY<br />

General Dentistry<br />

Schultz, Paul R DDS<br />

400 N Park Place<br />

Audubon, IA 50025<br />

(712) 563-2659<br />

BENTON<br />

COUNTY<br />

General Dentistry<br />

Sheronick, James K DDS<br />

201 1st Ave<br />

Van Horne, IA 52346<br />

(319) 228-8404<br />

BLACK HAWK<br />

COUNTY<br />

General Dentistry<br />

Bierciewska, Halina B<br />

DDS<br />

2765 Crossroads Blvd<br />

Waterloo, IA 50702<br />

(319) 233-2400<br />

Eastman, Chris DDS<br />

2765 Crossroads Blvd<br />

Waterloo, IA 50702<br />

(319) 233-2400<br />

Friedman, Thomas G<br />

DDS<br />

1047 Thorndale Ave<br />

Waterloo, IA 50701<br />

(319) 235-0164<br />

Wirth, Michael J DDS<br />

1029 W 4th St<br />

Waterloo, IA 50702<br />

(319) 235-0361<br />

BREMER<br />

COUNTY<br />

General Dentistry<br />

Haw, Richard C DDS<br />

113 W 1st St<br />

Sumner, IA 50674<br />

(563) 578-5232<br />

CARROLL<br />

COUNTY<br />

General Dentistry<br />

Berning, David L DDS<br />

409 W 7th St<br />

Carroll, IA 51401<br />

(712) 792-4776<br />

CASS COUNTY<br />

General Dentistry<br />

Kreifels, Timothy J DDS<br />

402 Poplar St<br />

Atlantic, IA 50022<br />

(712) 243-3275<br />

CERRO GORDO<br />

COUNTY<br />

General Dentistry<br />

Bierciewska, Halina B<br />

DDS<br />

4199 4th St<br />

Mason City, IA 50401<br />

(641) 423-9000<br />

McGregor, Michael DDS<br />

4199 4th St SW<br />

Mason City, IA 50401<br />

(641) 423-9000<br />

CLAYTON<br />

COUNTY<br />

General Dentistry<br />

Arvidson, James R DDS<br />

228 Main St<br />

McGregor, IA 52157<br />

(563) 873-3780<br />

Barron, John D DDS<br />

511 N Bluff<br />

Guttenberg, IA 52052<br />

(563) 252-2150<br />

Iowa<br />

<strong>Participating</strong> <strong>Dentists</strong><br />

DALLAS<br />

COUNTY<br />

General Dentistry<br />

Colwell, Gary W DDS<br />

906 Main St<br />

Adel, IA 50003<br />

(515) 993-3522<br />

DECATUR<br />

COUNTY<br />

General Dentistry<br />

Lesan, Terry B DDS<br />

1330 E Main St<br />

Lamoni, IA 50140<br />

(641) 784-6059<br />

DES MOINES<br />

COUNTY<br />

General Dentistry<br />

Bierciewska, Halina B<br />

DDS<br />

401 S Gear Ave<br />

Suite 101<br />

West Burlington, IA 52655<br />

(319) 754-1800<br />

DICKINSON<br />

COUNTY<br />

General Dentistry<br />

Fischer, Frederic R DDS<br />

2606 17th St<br />

Spirit Lake, IA 51360<br />

(712) 336-3037<br />

DUBUQUE<br />

COUNTY<br />

General Dentistry<br />

Bierciewska, Halina B<br />

DDS<br />

3432 Dodge St<br />

Dubuque, IA 52003<br />

(563) 557-0500<br />

Ghosheh, Natalie J DDS<br />

1645 John F Kennedy Rd<br />

Dubuque, IA 52002<br />

(563) 556-6383<br />

McDevitt, Lacy DDS<br />

3432 Dodge St<br />

Dubuque, IA 52003<br />

(563) 557-0500<br />

This list is subject to change.<br />

3<br />

Nemmers, James J DDS<br />

968 W 3rd<br />

Suite 100<br />

Dubuque, IA 52001<br />

(563) 583-5617<br />

Souto, William T DDS<br />

1789 Elm St<br />

Suite A<br />

Dubuque, IA 52001<br />

(563) 690-2863<br />

Walgren, James C DDS<br />

1122 Rockdale Rd<br />

Dubuque, IA 52003<br />

(563) 556-2650<br />

Pediatric Dentistry<br />

Cheung, Frederick K<br />

DDS<br />

1645 John F Kennedy Rd<br />

Dubuque, IA 52002<br />

(563) 556-6383<br />

FAYETTE<br />

COUNTY<br />

General Dentistry<br />

Bennett, Thomas L DDS<br />

104 N Walnut<br />

West Union, IA 52175<br />

(563) 422-3626<br />

Berryman, Clinton T<br />

DDS<br />

216 E Charles St<br />

Oelwein, IA 50662<br />

(319) 283-4981<br />

FLOYD COUNTY<br />

General Dentistry<br />

Buehler, Jodie A DDS<br />

705 N Main St<br />

Suite 3<br />

Charles City, IA 50616<br />

(641) 228-2936<br />

GREENE<br />

COUNTY<br />

General Dentistry<br />

Teusch, James R DDS<br />

207 W State St<br />

Jefferson, IA 50129<br />

(515) 386-4128<br />

Harrison County<br />

HARDIN<br />

COUNTY<br />

General Dentistry<br />

Stickrod, Dean R DDS<br />

1310 Washington St<br />

Eldora, IA 50627<br />

(641) 939-3214<br />

HARRISON<br />

COUNTY<br />

General Dentistry<br />

Garvey, Jeffrey T DDS<br />

214 E Erie St<br />

Missouri Valley, IA 51555<br />

(712) 642-4136<br />

73 7th St<br />

Woodbine, IA 51579<br />

(712) 647-2450<br />

Hermsen, Michael S DDS<br />

214 E Erie St<br />

Missouri Valley, IA 51555<br />

(712) 642-4136<br />

Macaitis, Michael K DDS<br />

214 E Erie St<br />

Missouri Valley, IA 51555<br />

(712) 642-4136<br />

73 7th St<br />

Woodbine, IA 51579<br />

(712) 647-2450<br />

Pietro, James Vincent<br />

DDS<br />

214 E Erie<br />

Missouri Valley, IA 51555<br />

(712) 642-4136<br />

73 7th St<br />

Woodbine, IA 51579<br />

(712) 647-2450<br />

Steckler, Kimberly A<br />

DDS<br />

214 E Erie St<br />

Missouri Valley, IA 51555<br />

(712) 642-4136<br />

73 7th St<br />

Woodbine, IA 51579<br />

(712) 647-2450<br />

Swartz, Thomas DDS<br />

214 E Erie St<br />

Missouri Valley, IA 51555<br />

(712) 642-4136<br />

73 - 7th St<br />

Woodbine, IA 51579<br />

(712) 647-2450<br />

Wang, Ruo-Yu J DDS<br />

214 E Erie St<br />

Missouri Valley, IA 51555<br />

(712) 642-4136


Harrison County<br />

Yang, Patty I DDS<br />

214 E Erie St<br />

Missouri Valley, IA 51555<br />

(712) 642-4136<br />

73 7th St<br />

Woodbine, IA 51579<br />

(712) 647-2450<br />

JONES COUNTY<br />

General Dentistry<br />

Oldham, Debra K DDS<br />

702 W Main St<br />

Anamosa, IA 52205<br />

(319) 462-2531<br />

Slater, Joslyn A DDS<br />

702 W Main St<br />

Anamosa, IA 52205<br />

(319) 462-2531<br />

Wolken, Richard J DDS<br />

216 N Main St<br />

Monticello, IA 52310<br />

(319) 465-4666<br />

LINN COUNTY<br />

General Dentistry<br />

Bahadur, Shachindra<br />

DDS<br />

2315 Edgewood Rd SW<br />

Cedar Rapids, IA 52404<br />

(319) 390-1400<br />

Bierciewska, Halina B<br />

DDS<br />

2315 Edgewood Rd SW<br />

Suite 160<br />

Cedar Rapids, IA 52404<br />

(319) 390-1400<br />

Choi, Charles J DDS<br />

3500 Center Point Rd NE<br />

Suite 3<br />

Cedar Rapids, IA 52402<br />

(319) 393-4828<br />

Wolken, Richard J DDS<br />

159 Marion Blvd<br />

Marion, IA 52302<br />

(319) 377-4225<br />

MILLS COUNTY<br />

General Dentistry<br />

Lothrop, Robert DDS<br />

112 S Vine<br />

Glenwood, IA 51534<br />

(712) 527-4854<br />

Weber, Calvin A DDS<br />

208 N Walnut St<br />

Glenwood, IA 51534<br />

(712) 527-4801<br />

Weber, George C DDS<br />

208 N Walnut St<br />

Glenwood, IA 51534<br />

(712) 527-4801<br />

MITCHELL<br />

COUNTY<br />

General Dentistry<br />

Buhrow, Guy R DDS<br />

816 N 8th St<br />

Osage, IA 50461<br />

(641) 732-4465<br />

O'BRIEN<br />

COUNTY<br />

General Dentistry<br />

Vander Berg, Michael<br />

DDS<br />

813 3rd Ave<br />

Sheldon, IA 51201<br />

(712) 324-3124<br />

OSCEOLA<br />

COUNTY<br />

General Dentistry<br />

Hauck, James M DDS<br />

106 Cedar Ln<br />

Sibley, IA 51249<br />

(712) 754-2761<br />

Johnson, Jerry L DDS<br />

611 3rd Ave<br />

Sibley, IA 51249<br />

(712) 754-2288<br />

Vadnais, Valerie M DMD<br />

611 3rd Ave<br />

Sibley, IA 51249<br />

(712) 754-2288<br />

POLK COUNTY<br />

General Dentistry<br />

Bates, Robert S DDS<br />

3710 Merle Hay Rd<br />

Des Moines, IA 50310<br />

(515) 270-1646<br />

Bierciewska, Halina B<br />

DDS<br />

2409 SE Delaware Ave<br />

Suite 100<br />

Ankeny, IA 50021<br />

(515) 963-4343<br />

4930 SE 14th St<br />

Des Moines, IA 50320<br />

(515) 953-6000<br />

Iowa<br />

<strong>Participating</strong> <strong>Dentists</strong><br />

Campbell, John E DDS<br />

215 Euclid Ave<br />

Des Moines, IA 50313<br />

(515) 288-1343<br />

Forsberg, Angela DDS<br />

2409 SE Delaware Ave<br />

Suite 100<br />

Ankeny, IA 50021<br />

(515) 963-4343<br />

Jennings, Adrienne<br />

DDS<br />

3710 Merle Hay Rd<br />

Des Moines, IA 50310<br />

(515) 270-1615<br />

Lubow, Richard M DMD<br />

4930 SE 14th St<br />

Des Moines, IA 50320<br />

(515) 953-6000<br />

McDevitt, Lacy DDS<br />

4930 SE 14th St<br />

Des Moines, IA 50320<br />

(515) 953-6000<br />

Meyer, John W DDS<br />

1701 22nd St<br />

Suite 101<br />

West Des Moines, IA 50266<br />

(515) 224-4867<br />

Nordmark, Boyd N DDS<br />

619 W Euclid Ave<br />

Des Moines, IA 50313<br />

(515) 243-2221<br />

Rieck, Terry R DDS<br />

4019 Ingersoll Ave<br />

Des Moines, IA 50312<br />

(515) 255-1195<br />

Sterba, Wayne DDS<br />

3710 Merle Hay Rd<br />

Des Moines, IA 50310<br />

(515) 270-1646<br />

Timmerman, Clinton S<br />

DDS<br />

11088 Hickman Rd<br />

Clive, IA 50325<br />

(515) 278-2253<br />

3710 Merle Hay Rd<br />

Des Moines, IA 50310<br />

(515) 270-1615<br />

Tongsiri, Amy DDS<br />

3710 Merle Hay Rd<br />

Des Moines, IA 50310<br />

(515) 270-1615<br />

POTTAWATTAM<br />

IE COUNTY<br />

General Dentistry<br />

Allen, Amber M DDS<br />

114 1/2 S 6th St<br />

Council Bluffs, IA 51501<br />

(712) 325-1544<br />

This list is subject to change.<br />

4<br />

Cardenzana, Andrea L<br />

DDS<br />

427 E Kanesville Blvd<br />

Suite 200<br />

Council Bluffs, IA 51503<br />

(712) 322-5318<br />

Colwell, Robert F DDS<br />

114 1/2 S 6th St<br />

Council Bluffs, IA 51501<br />

(712) 325-1544<br />

306 Front St<br />

Neola, IA 51559<br />

(712) 485-2033<br />

Dudzinski, Bernard P<br />

DDS<br />

2800 Twin City Plaza<br />

Suite 1R<br />

Council Bluffs, IA 51501<br />

(712) 366-7077<br />

Eischeid, Raymond H<br />

DDS<br />

427 E Kanesville Blvd<br />

Council Bluffs, IA 51503<br />

(712) 323-8402<br />

Garvey, Jeffrey T DDS<br />

114 1/2 S 6th St<br />

Council Bluffs, IA 51501<br />

(712) 325-1544<br />

Greer, Edward P DDS<br />

1920 Rue St<br />

Suite 2<br />

Council Bluffs, IA 51503<br />

(712) 329-8932<br />

Hale, Laura L DDS<br />

114 1/2 S 6th St<br />

Council Bluffs, IA 51501<br />

(712) 325-1544<br />

Higginbotham, Brad D<br />

DDS<br />

200 S 29th St<br />

Council Bluffs, IA 51501<br />

(712) 323-5801<br />

Johnson, J Terry DDS<br />

427 E Kanesville Blvd<br />

Suite 306<br />

Council Bluffs, IA 51503<br />

(712) 328-1885<br />

Lenaghan, Timothy J<br />

DDS<br />

320 Oakland Ave<br />

Oakland, IA 51560<br />

(712) 482-3316<br />

McArdle, Kent E DDS<br />

2800 Twin City Plaza<br />

Suite 1R<br />

Council Bluffs, IA 51501<br />

(712) 366-7077<br />

McGuire, Mark W DDS<br />

114 1/2 S 6th St<br />

Co Bluffs, IA 51501<br />

(712) 325-1544<br />

Scott County<br />

Ott, Sarah L DMD<br />

2800 Twin City Dr<br />

Council Bluffs, IA 51501<br />

(712) 366-7077<br />

Perry, Robert S DDS<br />

532 1st Ave<br />

Suite 210<br />

Council Bluffs, IA 51503<br />

(712) 322-3974<br />

Pietro, James Vincent<br />

DDS<br />

114 S 6th St<br />

Council Bluffs, IA 51501<br />

(712) 325-1544<br />

Rensch, Michael A DDS<br />

1601 McPherson Ave<br />

Suite 500<br />

Council Bluffs, IA 51503<br />

(712) 328-1810<br />

Ronk, Richard J DDS<br />

200 S 29th St<br />

Council Bluffs, IA 51501<br />

(712) 322-7912<br />

Schierbrock, Thomas R<br />

DDS<br />

427 E Kanesville Blvd<br />

Suite 200<br />

Council Bluffs, IA 51503<br />

(712) 322-5318<br />

Steg, Thomas B DDS<br />

317 Main<br />

PO Box 231<br />

Minden, IA 51553<br />

(712) 483-2122<br />

Warner, Richard W DDS<br />

1840 Madison Ave<br />

Suite 1<br />

Council Bluffs, IA 51503<br />

(712) 328-1100<br />

SCOTT COUNTY<br />

General Dentistry<br />

Alpen, Scott A DDS<br />

3575 Jersey Ridge Rd<br />

Davenport, IA 52807<br />

(563) 322-4433<br />

Baumgarten, Jameson C<br />

DMD<br />

4346 E 53rd St<br />

Davenport, IA 52807<br />

(563) 355-5393<br />

Griebahn, Lynn R DDS<br />

1905 Main St<br />

Davenport, IA 52803<br />

(563) 323-2571<br />

Hathaway, Alan D DDS<br />

1333 W Lombard St<br />

Davenport, IA 52804<br />

(563) 322-1451


Scott County<br />

Jennings, Valerie B DDS<br />

4624 Progress Dr<br />

Suite E<br />

Davenport, IA 52807<br />

(563) 355-1251<br />

Kramer, Margaret A DDS<br />

1905 N Main St<br />

Davenport, IA 52803<br />

(563) 323-2571<br />

Mueller, Gene V DDS<br />

2228 Hickory Grove Rd<br />

Davenport, IA 52804<br />

(563) 324-0212<br />

Twyner-Coley, Kathleen<br />

D DDS<br />

121 W Locust St<br />

Davenport, IA 52803<br />

(563) 322-7059<br />

TAMA COUNTY<br />

General Dentistry<br />

McLaughlin, Michael A<br />

DDS<br />

407 Wilson St<br />

Dysart, IA 52224<br />

(319) 476-4110<br />

TAYLOR<br />

COUNTY<br />

General Dentistry<br />

Sawyer, Steven DDS<br />

201 N Main<br />

Lenox, IA 50851<br />

(641) 333-4664<br />

UNION COUNTY<br />

General Dentistry<br />

Scott, William T DDS<br />

304 W Lucas<br />

Creston, IA 50801<br />

(641) 782-7587<br />

WARREN<br />

COUNTY<br />

General Dentistry<br />

Boone, Alan L DDS<br />

204 S Howard<br />

Indianola, IA 50125<br />

(515) 961-2125<br />

Cooney, Thomas R DDS<br />

215 N Buxton<br />

Indianola, IA 50125<br />

(515) 961-5351<br />

Lindeberg, Michael T<br />

DDS<br />

212 N Buxton St<br />

Indianola, IA 50125<br />

(515) 961-0534<br />

Zaborac, David A DDS<br />

212 N Buxton St<br />

Indianola, IA 50125<br />

(515) 961-0534<br />

WOODBURY<br />

COUNTY<br />

General Dentistry<br />

Clark, Thomas J DDS<br />

214 Main St<br />

Moville, IA 51039<br />

(712) 873-3525<br />

Iowa<br />

<strong>Participating</strong> <strong>Dentists</strong><br />

This list is subject to change.<br />

5<br />

Woodbury County


A<br />

Allen, Amber M DDS ....................................4<br />

Alpen, Scott A DDS.......................................4<br />

Arvidson, James R DDS ................................3<br />

B<br />

Bahadur, Shachindra DDS ............................4<br />

Barron, John D DDS ......................................3<br />

Bates, Robert S DDS......................................4<br />

Baumgarten, Jameson C DMD ......................4<br />

Bennett, Thomas L DDS ................................3<br />

Berning, David L DDS ..................................3<br />

Berryman, Clinton T DDS .............................3<br />

Bierciewska, Halina B DDS ......................3, 4<br />

Boone, Alan L DDS .......................................5<br />

Buehler, Jodie A DDS....................................3<br />

Buhrow, Guy R DDS .....................................4<br />

C<br />

Campbell, John E DDS ..................................4<br />

Cardenzana, Andrea L DDS ..........................4<br />

Carlson, Bruce A DDS ...................................3<br />

Cheung, Frederick K DDS .............................3<br />

Choi, Charles J DDS ......................................4<br />

Clark, Thomas J DDS ....................................5<br />

Colwell, Gary W DDS ...................................3<br />

Colwell, Robert F DDS ..................................4<br />

Cooney, Thomas R DDS................................5<br />

D<br />

Dudzinski, Bernard P DDS ............................4<br />

E<br />

Eastman, Chris DDS .....................................3<br />

Eischeid, Raymond H DDS ...........................4<br />

F<br />

Fischer, Frederic R DDS ................................3<br />

Forsberg, Angela DDS ..................................4<br />

Friedman, Thomas G DDS ............................3<br />

G<br />

Garvey, Jeffrey T DDS ..............................3, 4<br />

Ghosheh, Natalie J DDS ................................3<br />

Greer, Edward P DDS ....................................4<br />

Griebahn, Lynn R DDS..................................4<br />

H<br />

Hale, Laura L DDS ........................................4<br />

Hathaway, Alan D DDS .................................4<br />

Alphabetical Index of<br />

<strong>Participating</strong> <strong>Dentists</strong><br />

Hauck, James M DDS ....................................4<br />

Haw, Richard C DDS.....................................3<br />

Hermsen, Michael S DDS ..............................3<br />

Higginbotham, Brad D DDS ..........................4<br />

J<br />

Jennings, Adrienne DDS...............................4<br />

Jennings, Valerie B DDS ...............................5<br />

Johnson, J Terry DDS ...................................4<br />

Johnson, Jerry L DDS ....................................4<br />

K<br />

King, John T DDS .........................................3<br />

Kramer, Margaret A DDS ..............................5<br />

Kreifels, Timothy J DDS ...............................3<br />

L<br />

Lenaghan, Timothy J DDS ............................4<br />

Lesan, Terry B DDS ......................................3<br />

Lindeberg, Michael T DDS............................5<br />

Lothrop, Robert DDS ....................................4<br />

Lubow, Richard M DMD...............................4<br />

M<br />

Macaitis, Michael K DDS ..............................3<br />

McArdle, Kent E DDS ...................................4<br />

McDevitt, Lacy DDS ................................3, 4<br />

McGregor, Michael DDS ..............................3<br />

McGuire, Mark W DDS.................................4<br />

McLaughlin, Michael A DDS ........................5<br />

Meyer, John W DDS ......................................4<br />

Mueller, Gene V DDS....................................5<br />

N<br />

Nemmers, James J DDS.................................3<br />

Nordmark, Boyd N DDS................................4<br />

O<br />

Oldham, Debra K DDS ..................................4<br />

Ott, Sarah L DMD..........................................4<br />

P<br />

Perry, Robert S DDS ......................................4<br />

Pietro, James Vincent DDS.......................3, 4<br />

R<br />

Rensch, Michael A DDS ................................4<br />

Rieck, Terry R DDS.......................................4<br />

Ronk, Richard J DDS.....................................4<br />

This list is subject to change.<br />

7<br />

S<br />

Sawyer, Steven DDS.....................................5<br />

Schierbrock, Thomas R DDS.........................4<br />

Schultz, Paul R DDS......................................3<br />

Scott, William T DDS....................................5<br />

Sheronick, James K DDS...............................3<br />

Slater, Joslyn A DDS .....................................4<br />

Souto, William T DDS...................................3<br />

Steckler, Kimberly A DDS ............................3<br />

Steg, Thomas B DDS .....................................4<br />

Sterba, Wayne DDS ......................................4<br />

Stickrod, Dean R DDS ...................................3<br />

Swartz, Thomas DDS ...................................3<br />

T<br />

Teusch, James R DDS ...................................3<br />

Timmerman, Clinton S DDS .........................4<br />

Tongsiri, Amy DDS ......................................4<br />

Twyner-Coley, Kathleen D DDS ...................5<br />

V<br />

Vadnais, Valerie M DMD..............................4<br />

Vander Berg, Michael DDS ..........................4<br />

W<br />

Walgren, James C DDS .................................3<br />

Wang, Ruo-Yu J DDS ...................................3<br />

Warner, Richard W DDS ...............................4<br />

Weber, Calvin A DDS ...................................4<br />

Weber, George C DDS ..................................4<br />

Wirth, Michael J DDS ...................................3<br />

Wolken, Richard J DDS.................................4<br />

Y<br />

Yang, Patty I DDS .........................................4<br />

Z<br />

Zaborac, David A DDS ..................................5


Dentist Nomination Form<br />

If the dentist of your choice is not listed in this directory, you may complete this form to<br />

nominate the dentist to participate in the CONNECTION <strong>Dental</strong> Network. An application<br />

packet will be sent to eligible providers. The normal time frame for credentialing of dentists<br />

takes approximately 60 days after application has been received.<br />

Dentist Information<br />

Name: ________________________________________________________________<br />

Address: _______________________________________________________________<br />

________________________________________________________________<br />

Phone: __________________________________ Fax: _______________________<br />

Member Information<br />

Name: _______________________________________________________________<br />

Address: _______________________________________________________________<br />

_______________________________________________________________<br />

Phone: __________________________________Fax: _________________________<br />

Member Identification Number: _____________________________________________<br />

Employer Group Name: _________________________Group Number:______________<br />

Please mail the form to the following address:<br />

<strong>GEHA</strong> <strong>Dental</strong> Administration<br />

P.O. Box 455<br />

Independence, MO 64051-0455<br />

Or fax to <strong>GEHA</strong> <strong>Dental</strong> Administration at 816-257-3358<br />

Thank you for your interest in the CONNECTION <strong>Dental</strong> Network.

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