Jeffrey R. Wert D.M.D., P.C.
P.O. Box 485
Route 611
Tannersville, PA 18372
570.629.1570
570.629.1187 fax
drwert@ptd.net
Insurance Info & Forms
We are participating providers for the following insurance companies:
- United Concordia - Chips, Highmark and Preferred (Concordia Plus is excluded)
- Aetna PPO
- Delta Dental (including AARP)
- Metlife PDP
- NCAS
- Guardian PPO
- Cigna PPO
- Capital Blue Cross
* Please verify with your dental insurance carrier if our practice participates with your particular plan/group
Can I make payments? Sure you can. This service is provided through Carecredit (Click to apply).
Registration & Privacy Forms
Download and fill out the forms below to save valuable time prior to your visit.
Patient Registration Form (Download)
Medical History Form (Download)
Privacy Form Pages 1 & 2 (Download)
Privacy Form Page 3 (Download)
Note: You will need Adobe Reader to view these forms. If you do not have Adobe Reader you can download it for free at (Adobe.com).
Forms of Payment
| Cash | Check |
VISA |
Mastercard |
AMEX |
Discover |