Getting acquainted with Coastal Dental, Inc. is easy. Download and print the Producer Agreement below. Complete, sign and return to Coastal Dental, Inc.. You will need to include:
1. A copy of your State Insurance License(s).
2. Your Social Security Number if you are being paid as an Individual
or a Federal Tax I.D. if commissions are being paid to a firm
3. A completed W-9 form
Send all documentation to:
Coastal Dental, Inc.
Smoke Tree Plaza
601 Daily Drive, Suite #205
Camarillo, CA 93010
Once we receive the required documentation, you will receive your introduction package with training material to assist you in servicing your clients.
