HomeMy WebLinkAboutSAFEGUARD HEALTH PLANS, INC. -1992FITP CONTIZACT FOR PREPAID SE1VI...,
It is agreed between die ORGAW.ATION named in the Croup Contract for Prepaid Services Acceptance Agreement
(hereinafter referred to as " R AIU ATI N" ) and SAFEGUARD HEALTH PLANS, INC., a California corporation (hereinafter
referred to as "SAFEGUARD"), that:
A. SAFEGUARD is a California corporation, licensed as a Health Care Service Pian under applicable Callfomia
law, whose r e is t operate vario€�s dental health care service plans. Said services are established on a prepaid closed
primary P�
panel capltted basis.
B. ORGANIZATION desires to obtain the services herein specified for and on behalf of its Eligible Participants
as deflned herein.
NOW, THEREFORE, the parties do mutually covenant and agree as follows:
I. REFERENCE T_ ATTACHMENTS
This Contract, together with the Group Contract for Prepaid Services Acceptance Agreement (the '"Acceptance
Agreement"), Schedule of Benefits and Copaym nts and any Amendments, Dentist Directory, or other attachments hereto
constitutes the entire agreement of the parties.
DEFINITIQNS
l BENEFIT PLAN shall mean the coverage provided in the schedule of Benefits and Comments; the Schedule of
Limitations and Exclusions, and the Administrative Policies.
2.2 FQEAYMENrT shall mean an additional fee charged by Dentist to the member.
2.3 DENTIST QR PARTICIPAMG DENMS shall mean the dentist licensed by the Mate of California under contract
to SAFEGUARD, and shall include any by ienists and technicians recognized by the dental profession who act with and assist the
dentist.
2.4 DEPEMD—E 'T shall mean the lawful spouse and children, if enrolled in the Plan, of a member, including the
definitions and terms contained in Paragraph 3.6.
. FICA PARTICIPANT: shall mean an employee, member, or-beneficiary of RCAF TI I who is eligible to
participate ate in the SAFEGUARD Flan under the eli ibilit y requirements determined by ORGANIZATION.
2.6 MEMBER shall mean an eligible participant who is actually enrolled in the SAFEGUARD Plan. The tens
"Member" or "Members it, as used herein, shall be deemed to include all Subscribers and eligible Dependents as defined herein, if so
enrolled in the Plan.
.7 R GAI 11ZA I N means an association, employer, group or other organization to which the member belongs and
which is the contracting entity as set forth in the Acceptance Agreement.
. or SAELGUAR shall mean Safeguard Health Plans, Inc., a corporation licensed to provide prepaid dental
services under the Knox-Keene Health Care Service Plan Act of 1975, as mended.
2.9 SLWSMBER, shall mean the person whose relationship with the ORGANIZATION is the basis for eligibility for
membership in the Plan.
III. PREPAYNaNT EEE AND ELIGIBILITY
3. I As set forth in the Acceptance Agreement, ORGANIZATION shall Pay SAFEGUARD the appropriate nionthly
fee r mo��tb for eacb covered Member, as applicable, commencing on the effective date of this Contract, which sure
prepayment �
shall a the guaranteed monthly prepayment fee until contract renewal date.
3.2 The re P ayment fee is pain b Ii R A ATI N. The Subscriber may be responsible for a portion or the
prepayment ent fee and if so, such contribution will be deducted from the Subscriber`s earnings by payroll deduction or otherwise paid
to ORGANIZATION in such manner as it may select. If the Subscriber is responsible for fifty percent (50%) or more of the
prepayment fee, the Subscriber shall remain enrolled in the Plan for a minimum of twelve consecutive months unless earlier
terminated from ORGANIZATION. In the event such a Subscriber terminates enrollment in the Plan within the first twelve (12)
months of coverage, the Subscriber will be ineligible tore-enroll in the Plan for a period of twenty-four 24 months after such
termination. rmination. Ire all occasions, ORGANIZATION shall nevertheless be fully responsible for all payments of the prepayment fees due
under this Contract. The, pym ent of this Sum shall relieve OR A LZA'nON and Subscribers of any der liability hereunder.
3.3 ORGANIZATION acknowledges and understands that this Contract provides solely and exclusively for services
to b Pe rformed at dental facilities provided by SAFEGUARD. This Contract provides for services only, is not an insurance policy
and does
not indemnify or reimburse any Member or ORGANIZAIION in cash or any manner whatsoever, except as set forte in
Paragraphs 4.6.
ORGANIZATION shall send one check
covening all Members to SAFi j AF D at the add ss indicated in
Paragraph a a specified
Paragraph f the Accepta e Agreement, and continuing
g each r, oath thereafter on said date, for
ft d urtion of this contra
ct . ORGANUATION shall also send an eligibility list via hard copy, mag fletic tape or other electronic
' SAFEGUARD specifying the names and other identifying data for each Menib r to be co��ered for succeeding
n�edrun� t �A�
niontli. Said eligibility list shall list information exclusively for Safeguard and shall:
a Pc
cif calls identify those Members who are newly eligible to receive services.
h) Specifically identify those Members who are no longer eligible to receive services.
(c) Be
provided to SAFEGUARD no late` than the twenty #f�if` day o the month prec di g a rn nth during
which Members will be eligible for benefits.
3J* determination of who is eligible to participate and rbo is actually participating in the � shall be
determined rAIIZA
T`l and SAFEGUARD shall have the right to rely upon that detenrnaon. Any disputes or rnuis
regarding eligibility, including g . r regarding
hts renewal, reinstatement and the like, if any, shall referred by SAFEGUARD to
��
ORGANIZATION, which shall then advise SAFEGUARD of its determination.
(a ) DeDependents shall include the lawful spouse of the Subscriber, and all newborn infants whose coverage
. ter the nio ent of birth. Legally adopted children and stepchildren shall b covered from and after the
shall connence l~ro�n ar�d of
date of placement. Subject to
notification to SAFEGUARD by NI A' N and payment of the appropriate prepayment fee,
if any, dependents shall be eligible for coverage on the day the Subscriber i for or coverage or on the day the Subscriber
acquires such Dependent, whichever i later.
under the ale specified
Dependents shall also include all unmamied children fied in paragraph � e
who are chiefly dependent on the Subscriber for support. Eligibility may be extended p to the age
Acceptance Agreement l
b of the Acceptance Agreement for unmarried children who are principally dependent upon the
specified ��� l'aap F
'
Subscriber for maintenance an support re d su rt and are registered students in regular, full-time attendance at an accredited school, college
g `
or university+
c)
Coverage shall not terminate while a dependent child is and continues to be i) incapable of self -
sustaining employment by
reason of mental retardation or pbysical handicap; and H chiefly dependent upon the Subscriber for
support and maintenance
provided the Subscriber fumishes proof of such incapacity and dependency to SAFEGUARD within }
' `nin the limiting age set forth in paragraph b) above, and every two ( ) years thereafter, if
thirty-one � 1) days of the child at �.
requested by SAFEGUARD.
AII�T`�1 fail to pay the monthly prepay�n�ent fee for any member when due, SAFEGUARD nay,
. Should ORS p
' member from its list of eligible members. Should ORGANIZATION subsequently pay SAFEGUARD
at its discretion delete said g
all mounts dui, SAFEGUARD � reinstate any reinsta an y member deleted from said eligibility list. Should ORGANUATION fail to notify
SAFEGUARD of a member wlio is do lon er eligible for benefits, pursuant to paragraph 3.4 above, SAFEGUARD shall continue to
be enti tled to its m prepayment fee for such Members until such time as SAFEGUARD i notified in Ming of the
onthl p re p
` t + n and the Subscriber and his or her Dependent(s) are removed from the eligibility list specified above.
�ubs�ber s ter'n�rnatro , a
Should SAFEGUARD be
notified of a Subscriber's ternnination after the eligibility list is prodded by ORGANIZATION to
SAFEGUARD, coverage for the
Subseniber and his or her Dependent(s) shall continue until the end of the applicable monthly:
period, if ably, and SAFEGUARD shall retain or must be paid the applicable prepayment fee to the end of the monthly period for the
4
Subscribes and his r her Dependent(s).
' it Dependents are ell ,lble to become Members o#` SAFEGUARD at the One designated by the
3.8 Subscribers and the g
ORGANIZATION as of the effective date of this Contract. For the Subscribers of the ORGANIZATION wbo become eligible as
+ l ter the effective date of this Contract, the effective date of eligibility shall be subject to the
determined b� the ORGANIZATION of
eligibility rules of the ORGANIZATION.
W. ADMIMSTRAT1 �
A D is obligated to give any notice o Members with regard to any matters covered by this
. i 4'henever SAFEGUARD g
Care Service Plan Act of 1975, as amended, or any regulations issued pursuant thereto by the
Contract, e Knox-Keene k�ealtll Car such notice to a representative o
California ar►e�nt of Corporations, it shall sufficient for SQUID to gives
ORGANIZATION sh" then b obligated to give that nonce to the Members in its next regular
n shall such notice be given later than thirty fl days after SAFEGUARD gives such notice to
conuacat�on. but in no event g h f` e
R�rA�ATT
. The ORGANIZATION representative designated to receive such notice is set forth in Paragrap
Acceptance Agreement,
'ors of all mater-* a1s, such as a Combined Evidence of Coverage and Disclosure Form and
. With regard to the distribution
` distributed pursuant to the Knox -Keene Health Care Service flan Act of 19'75, a amended, or any
other material recurred to be d�trx p
regulation issued pursuant the et r o it shad be sufficient for SAFEGUARD to deliver the material for distribution to the
A'TI N designated in Paragraph A of the Acceptance Agreement. ORGANIZATION shall be
representative of I� g -
responsible to distribute such mterial to Subscribers and/or Eligible Participants. -
} L fi Y# s 34+4+ t a J i7 #%rAIALrwrA 1�4+f A JL 0 V4L t •
I�. +%ALJA%el a •L• 1..5+ri, 4■ .�-.� -... ... k- -
..
and all complaints received d from Members ��' regard a nature o professional services rendered. Any inquiries, complaints or
GUAR: wr`itin or calling SAFEGUARD at the ' •es indicated in Paragraph ,a, and
� Hike, shall � made to SAFE its Member
�'I� rare '
telephone number indicated in Paragraph .(a. SAFEGUARD has previously: made 'A.�A
Services procedures.
' Dependents who enroll in the Plan at the inception f this Comma and after Wining a list
. For all Subscribers and pe
. h ubs�ber and Dependent from RGAI UA` , SAFEGUARD shall issue are identification
or other identifying) data for each � thereafter for
card t each Member, identifying that Member as being eligible for service provided by this contract. Each month there
new Members who enroll in
e Plan and after ORGANIZATIONs notification to SAFEGUARD of said new Members
enrollment, SAFEGUARD shah issue an identification card, as set forth abOvc. �
4.5 On e Subscriber's enrollment form- each Eligible Participant or Dependent who i eligible to receive benefits ,
�
select the Dentist the Member wishes tog
o to for services provided for herein. Whereafter, to obtain services, the Member reed
only contact the selected Dentist
. In the event a Member desires to transfer to another Dentist, the ember may do so by
number cued in Paragraph a, and transfer to another Dentist listed herein,
contacting SAMG�IRD at the telephone �
effective the f`ust day of the following month. t ' d ays a weep. In the SAFE
SAFEGUARD shall provide emergency dental services twenty -four (24) hours a day, m en
' service area which is defined s being within twenty-five miles of the Member's selected
event the Member � �n the Plan se � make �'s selected Dentist who will
Dentist, and is in need of emergency denW services, the Member shall contact Me mbe
reasonable armgements for such emergency h emer denW services. If the Member's Dentist is unavailable, the Member may obtain
y
i e from an licensed dentist. [upon verification of the unavailability of the Member's Dentist,
emergency dental services y
• Member for the cost of such emergency dental services, less any applicable Copa went s , up to a
SAFEGUARD ��� reimburse the �e
axum of fifty dollars .00. Expenses for covered benefits required iD a dental emergency, rendered by a licensed dentist
outside the Plan service area which is defined as bein more than twenty -five (25) miles from the f ember's selected Dentists g WW
be
reimbursed to the Member, by SAFEGUARD, up to a maximum of fifty dollars (S50-00).
is Contract emergency dente services means dental services rendered for the relief of per,
As used within
'
bleeding or any condition ` which may result in disability or death only and where delay of treatment would be medically
• e dental services required for such conditions and any further dental treatment or services
inadvisable. the Plan covers only thus �
• t Dentist. nest'eburserrent, the Member shall send a bill incurred s a result of
must be provided by the Member's s selected Deng t � dress set f� in Paragraph a.
dental emergency, maned aid, or other evidence of payment to SAFEGUARD at the ad
such de p
No claim forms are required to be submitted by the Member. ices to Members.
. n SAFEGUARD shall maintain dental facilities at appropriate location to provide sere
' establishment, maintenance and location of all dental facilities are within the sale discretion
fRA�A'�'I� recognizes that e
of SEAR and SAFEGUARD
shall make the sole determination of the location and establishment of all such dental
• • o promptly notify Members and RGAI� A� N in writing of the ten nin,ation s closure o any
facilities. SAFEGUARD agrees t p y
• ` * ' transfer Members to existing or alternate dental fclIities on this Benefit Pfau. A list of e
participating dente f'acdt and to trans g d Dentist Dirctr�.
names and addresses of the initial Participating Dentists for this Benefit Plan is attached mark
V. DF
JaIST-PAIMNIRELATIONSMP
,5.1 It is expressly
r understood that the relationship between the Member and the Dentist rendering services or txatment,
d incident to the professional relationship, and SAFEGUARD's Peer Review
shall be subject to the razes, limitations an privileges ember, without interference from SAFEGUARD or
and Public Polley omittees, The Dentist shad be solely responsible to e M ,
atment within the professional relationship. The Dentist have the right to refuse shall
RAI��AI # for all services or tie
treatment to a Member who continually fails to follow a Prescribed cou of treatme rat who uses the relationship for illegal
purposes, or makes the professional relationship onerous. modem dental facilities available in the
. • While SAFEGUARD desires and will actively seek to maintain the 1mOst of
F at the operation and maintenance of the Dentists facility, equipment and the rendition
profession} �t �s understood and agreed that � ` n f the Dentist,. including all authority and
all professional services shall be solely and e�cclu�si�rely under a control and supervision , .
of personnel, and operation of a professional prac�ce, and/or the mndrarn of anY
control over the selection of staff, supervision � �
particular professional service or treatment. ormed in
undertake to see that the services provfded to Members b Dentists} shall be per`
SAFEGUARD will n liable, prevailiu in e
accordance with
rofessional standards of reasonable competence and skill o dental practitioners} as app g
community n which each Dentist practices.
6.1
've on the date indicated in Pararapb B of the Acceptance Agreement, and shall
This ontxct sham be effect
h of the Acceptance Agreement. Plan coverage "I commence n the
continue to the end of a prod specified �n Paragraph P _
i ted in Para ra h o the Acceptance Agreement, and shalt continue for the period se t forth in Para g
raph of the
date end � g
Acceptance Agreement.
. The parties may
renew contract at a end the term hereof, and consent modify ify or alter this
that said modifications, amendme is, alterations or renewals shall be in writing, duly executed by
Comma; provided, however,
both parties hereto, and attached to this Contract. Failure by either party to terminate this Contract by giving the other party sixty
0 days written no p notice rior to the termination date of this Contract, shall automatically rene W this Contract for a like term as indicated in Paragraph C of the Acceptance Agreement. fees or vide an
.3 Should the ORGANIZATION be in default by the failure to remit the monthly prepayment s
. .. i Section I herein, SAFEGUARD shall have the right to terminate this Contract upon fifteen f days
el�.ib��ty list a recurred by �ect�
• l then have fifteen 1 days to remit the monthly prepayment fees# or proyide the eligibility
written notice. ORGANIZATION �
' . Termination shall be effective the last day of the month in which the fifteen 1 day period
list when due, from receipt f nonce
'n the o days f termination of this Contract refund to ORGANIZATION the pro rata pion
expires. SAFEGUARD shall within y n received. SAFEGUARD
a ent fee which corresponds to any une pffed terms f'or which prepayment fees have bee
of the prep ynn
shall be paid its prepayment fee to date of termination.. nt ct for non- a eat, �l
Receipt SAFEGUARD of the proper prepayment fee after termination of this P ym
p y h prepayment fee is received y SAFEGUARD n r before the
reinstate this contract as though it had sever been terminated, ` suc Mowing acts shall
snceedin prepayment fee. however, performance by SAFEGUARD of any one f the folio
. due dtethnt
avoid any such reinstatement:
SAFEGUARD refunds such payment within five business days or, if such payment is received more than
five business days after issuance of a notice of termination, within fifteen ( 1 ) business days.
f
SAFEGUARD issues to ORGANIZATION, within five t business days of receipt of such payment, a new
' notice stating clean those respects in which the new contract dif'f'ers from the terminated contract
contract accompanied b written
in benefits, coverage and otherwise.
Subscriber terminates employment or association with ORGANIZATION, or i certified by
In the event a S p for such terminated subscriber and his or
ORGANIZATION as being no longer eligible for benefits provided for herein, coverage
her Dependent(s) shall cease fee
e the last day of the monthly period for which ORGANIZATION has paid the applicable prepayment
to SAFEGUARD for the terminated Subscriber and his or her Dependent(s). n started
b. In the evert of termination o this Contract, each Dentist shall complete all dental procedures which have been
' t to the tens of this Contract with the exccption of any orthodontic trea ent� as may be
prior t the date f terrn�r�at�on� pursuant
l b governed b the Orthodontic Limitations and occlusions set forth in the Schedule of
applicable. Orthodontic treatment shat y
Limitations and Exclusions.
ent fees from the date such fees are due, will b charged at a rate equal to eighteen
6.7 Interest on late p re a p � .
' will be due and payable n notice thereof to ORGANIZATION from SAFEGUARD.
percent l per gear. Unpaid interest p y p° 1 as amended, any M ember ►bo
. pursuant to Section 1b of the Knox -Keene Health Care Service flan Act of
alleges his enrollment has
en canceled or not renewed because of his health status or requirement for services, may request
review by the California Department of Corporations.
1 EN EMS TO BE PROVIDED -- BENEFITS, COPAYMENTS9 LIMUATIONS,
I
AND AD I T I
?.1 SAFEGUARD and O GAN A'MN agree that SAFEGUARD shall provide services to Members f ORGANIZATION under the Benefit plan set forth in the Schedule of Benefits and Copayments, of Limitations and
Exclusions, and Administrative Policies.
t rendered to a Member result faro a Workers' Compensation injury claim, the Member
.2 �l�orid and benefit or service e
shall assign his rights to reimbursement th ' en from other sources for services rendered to the Member, to the Dentist rendering such
services.
7.3 The Member and not
SAFEGUARD nor ORGANIZAIION shall be solely responsible for payment of all
opayrnents and for any excluded procedure, and shall make payment therefore directly to the Dentist rendering such services.
that Participating Dentists shall abide by the Benefit Plan as set forth in this Contract.
'. SAFEGUARD agrees
. will not increase the prepayment fees as set forth in Paragraph G of the Acceptance Ag ennent;
SAFEGUARD further' agrees that it
that it will not modify the Schedule of Benefits and opaent; and that it will not modify the Schedule of Limitations and
Exclusions or any Administrative Policy during the term of this Contract.
No
_ten-
I U BVIN I �3 LO' 1 9
-
■
8. � .acb and
every disa .v- - meat, dispute or controvers t which remains unresolved, concerning the constxuct'on,
• is Contras or the provision of dental servic y ider this Contract, arising between the
interpretation, performance or breaeb G. � t� the n a , and SAFEGUARD.
ORGANUATION, Member or the heir -at -lay r personal representatiN c Of such persons as
participating
its ernploye, off`�cers, or directors, or Dentists or their dental groups, partners, agents, or employees, shall be
' accordance, with, and ursuant to, the commercial arbit�rabon rules of the American Arbitration
submitted to arbitration in accordn p . � r otherv4rise. This includes, without linrriti.ion,
Association then is effect# whether such dispute involves a clams �n tort, contras r contract were
i bilit or mal ractice, that is a to whether any dent services rendered und. t
a disputes a to pr'ofessloual l p
r were improperly., ne l�ently or incompetently rendered. It also inelues, w�tlrut limitation, and
unn or unauthorized rise to a clan after the termination of this Contract.
act or omission which occurs during the term of this Contract but which gives
(b) As a condition submission to
. n o f enrollin g in the f Plan, all Members agree that all disputes will b detem n d by .
�
t lawsuit or resort t court except a California law provides judicial review
arbitration a provided herein, and not b a la process,
of arbitration proceedings.
{c The locale of the arbitration shah be
et of Las Angeles, aiira, unless all parries to arbitration
otherwise mutually agree in westing.
ward to a party, the arbitrators shall state what portion of the award shall'be
(d If the arbitrators shah make an a
' ute t d amages ages and Which portion shall be attributed t nor- eeonoi tae.
attnb
.. n notice to the President of SAFEGUARD HEALTH PLANS, INC., 505
e Arbitration shall b initiated b tte l
North Euclid Street, P.O. Box lo, Aahhn, California 92803 -3210. The nonce shall include a detaed description of the matter
to be arbitrated.
indemnify f and hold A�ZATI i harmless from and against any and all m juries,
8. SAFEGUARD shall defennd, n emu which ORGANIZATION I its
claims demands, mobilities, curt~ at haw r in equity, orr�drnents of any nature whatsoever, dice or
third artier n-►a sustain or Inc reason of any act, neglect, default, alleged malpractice
employees, representatives, agents or p
inadequate care or service rendered to the Member by any Dentist or dental facility. as a
waiver of one or more defaults, if any, under this Contract shall not b construed t operate
The �rer b ether party
' condition or covenant or any other condition r covenant contained within
waiver of any otli�' or future default, ether in the �
this Contract.
• � either a. to serve notice on the other �n respect of this Con�c such notice
. whenever it becomes necessary for eith p
shall be in writing and sba.11 be served registered or certified mail, return
receipt requested, addressed as indicated below:
a If addressed to SAFEGUARD, it shall be addressed as follows:
SAFFG ARD HEALTH PLANS, INC.
505 North Euclid Street
P.O. Box 321
Anaheim, California 92803 -3210.
fb If addressed to
GAIATINs it shall be addressed as indicated in paragraph A of the Acceptance
Agreement.
. a The telephone number of SI�# Member services Department is � 352 -�.
b The telephone number of SAFEGUA D's Client Services Department is (800) 962- 1836.
• l include the plural and the plural the singular; the masculine shall include
8.b Throughout this Contract, the singular shat p
e neuter and feminine; and the neuter shall include the masculine and feminine. regulations
.'� This Contract is subject to the Knox - Keene Health Care Service Plan Act of 1975, as mended-, an to re g
• rations. Should either the law or the regulations be arnended� such
issued pursuant thereto by the California foria Department o precedence over any inconsistent provision
amendments shall automatically be deemed to be a part of this Contract and shall take i the
' o be in this Contract by either the later or the regulations, shah automatically b
or this contract. Any provision rum t
parties whether or not included in this Contract. for covered services rendered by sueb
Upon n termination of dental contract, SAFEGUARD shall be fable
Member who retains eligibility under this Contractor by operation of �law,
Dentist, other than for �opayment or exclusions t a ire rendered to the Member by such Dentist are
under the care f such Dentist at the time of such termination until the services b ti
completed, unless SAFEGUARD makes reasonable and appropriate provision for the assumption of such services by another
Dentist.
fails to pay a P.rticl ating Dentist a may be required, neither the Member nor
�n e went �A��LIA.D p p the Dentist, the event Member
ORGANIZATION I shall b liable to the Dentist for any sums owed by SAFEGUARD to r
. and SAFEGUARD fails to pay the non
��AFEAD dentist, the Member
receives services from a nor- SAFEGUARD dentist,
may be liable to the non-SAFEGUARD dentist for the cost of services rendered. not affect the
8.1 any provision of this Contract is held to be illegal or invalid for any reason, such decision "I
• - b rennin visions shall continue in full force and effect unless the
validity of the remaining provisions of this Contract, and such p
' invalidity prevent the accomplishment of a objectives and purposes of this Contract.
illegality or � y p
. i a V x�1• � x . vV s vJIL0b .41 v.�.v "z. A 16, %.-a t.w►.., .. V$ aF ti %3 y . &&& h !L a• LIa �a6"1% -7 +�.
• SAFEGUARD; and such sale, assignment, or nn
shall be null and void and sWl act as a default f this
written consent of SAFEGUARD,
Coract. SAFEGUARD
'consent to t n sale, assignment or transfer shall not wa�v 'is right with respect to declining to
consent to any other sale, assignment nment of transfer. This Contract shall not be assigned, ti s.-.0ferred, or set over, eider voluntadly or
• law, r otherwise, including but not limit to any proceeding initiated under the Bankruptcy Act
involuntarily, air operation o
and/or the appointment of a trustee or receiver, whether bar state or federal court, r otherwise. s
an of a laws o the noted States, PrPo
exception to the
provisions of this paragraph= either party may sell, assign, and transfer its rights and delegate its duties
hereunder to any entity into which it is merged} or which acquires substantially all of its assets.
8.12 the event
ORGANIZATION IO i
{ -.,CHEDULE OF BENEFITS AND COPAL ,ANT'S
CITY OF SANTA A T
CLIENT #41
PRO C
CPA4YMNT
CODE
MEMBER SERVICES:
MEMBLR PAYS:
DIAGNOSTIC TREATMENT:
00110
INITLAL ORAL. EXAM
NO CHARGE
00111
INITIAL ORAL ELI - CHILD
NO CHARGE
00120
PERIODIC ORAL EXAM
NO CHARGE
00130
EMERGENCY ORAL EXAM
NO CHARGE
00210
INTRAORAL } COMPLETE SERIES (INCLUDING BITEWIN
NO CHARGE
00220
IN'I I_, } PERIAPICAL FIRST FILM
NO CHARGE
00230
INTRA RAL - PERIAPICAL - EACH ADDITIONAL FILM
NO CHARGE
00240
INTRARAL - OCCLUSAL FILM
NO CHARGE
00250
EXTRA ORAL - FIRST FILM
NO CHARGE
00260
EXTRA ORAL - EACH ADDITIONAL FILM
NO CHARGE
00270
BITEWING - SINGLE FILM
NO CHARGE
00272
BITE N - TWO FILMS
NO CHARGE
00273
BTTEWINGS - THREE FILMS
NO CHARGE
00274
BTTE�&qN S - FOUR FILMS
NO CHARGE
00275
BITEWINGS - EACH ADDITIONAL FILM
NO CHARGE
00330
PANORAMIC FILM
NO CHARGE
00460
PULP VITALITY TESTS
NO CHARGE
00470
DIAGNOSTIC CAS'T'S
NO CHARGE
00471
DIAGNOSTIC PHOTOGRAPHS
N CHARGE
PRENTNTP& S R qCE .
01110
PROPHYLAXIS - ADULT
NO CHARGE
01120
PROPHYLAXIS YLAXI - CHILD
NO CHARGE
01201
TOPICAL APPLICATION OF FLUORIDE
(INCLUDING PROPHYLAXIS) ` CHILD
NO CHARGE
01203
TOPICAL APPLICATION OF FLUORIDE
(EXCLUDING PROPHYLAXIS) - CHILD
NO CHARGE
01204
TOPICAL APPLICATION OF FLUORIDE
(EXCLUDING PROPHYLAXIS) - ADULT
NO CHARGE
01205
TOPICAL. APPLICATION N F FLUORIDE
(INCLUDING PROPHYLAXIS) ADULT
NO CHARGE
01330
ORAL HYGIENE INSTRUCTION
NO CHARGE
01351
SE - PER TOOTH
NO CHARGE
01510
SPACE MAINTAINER - FIXED - UNTLATERAL
NO CHARGE
01515
SPACE MAINTAINER - FIXED BILATERAL.
NO CHARGE
01520
SPACE MAINTAINER - REMOVABLE # UNILATERAL
NO CHARGE
01525
SPACE MAINTAINER - REMOVABLE - BILATERAL
NO CHARGE
01-550
RCEMENTATIN OF SPACE MAINTAINER
NO CHARGE
-.,CHEDULE OF BETE 'I i S AND COPAL. �NTS
CITY OF SANTA ANTA
CLIENT #41
COA`MNT
PRO C
COTE
MEMBER SERVICES:
MEMBER PAD'S:
RESTORATIVE TREATMENT:
02110
AMALGAM - ONE SURFACE, PRIMARY
NO CHARGE
02120
AMALGAM - TWO SURFACES, PRIMARY
NO CHARGE
221
GAM - THREE S RF CESy PRIMARY
NO CHARGE
02131
AMALGAM - FOUR SURFACES, PRIMARY
O CHARGE
02140
AMALGAM - ONE SURFACE, PERMANENT
NO CHARGE
02150
AMALGAM - TWO SURFACES, PERMANENT
NO CHARGE
02160
AMALGAM - THREE SURFACES, PERMANENT
NO CHARGE
02161
AMALGAM - FOUR OR MORE SURFACES, PERMANENT
NO CHARGE
02210
SILICATE CEMENT - PER RESTORATION
NO CHARGE
02310
COMPOSITE RESTORATION
NO CHARGE
02330
RESIN - ONE SURFACE, ANTERIOR
NO CHARGE
02331
RESIN - TWO SURFACES, ANTERIOR
NO CHARGE
02332
RESIN - THREE SI, F CES, ANTERIOR
NO CHARGE
02335
RESIN - FOUR OR MORE SURFACES, ANTERIOR
NO CHARGE
CROWNS R BRIDGES - PER UNIT:
02740
PORCELAIN CERAMIC. SUBSTRATE
NO CAGE
02750
PORCELAIN FUSED TO HIGH METAL
NO CHARGE
02751
PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
NO CHARGE
02752
PORCELAIN FUSED TO NOBLE METAL
NO CHARGE
02790
FALL CAST HIGH NOBLE METAL
NO CHARGE
02791
FULL CAST PREDOMINANTLY BASE METAL
NO CHARGE
02792
FULL CAST NOBLE METAL
NO CHARGE
02810
3 OAST METALLIC
NO CHARGE
02830
STAINLESS STEEL. CROP
NO CHARGE
02891
CAST POST & CORE
NO CHARGE
02892
DOWEL POST WITH CORE
NO CAGE
02910
REOENIENT UqlAy
NO CHARGE
02920
RECEMENT CROWS
NO CHARGE
02930
RECEMENT BRIDGE
NO CHARGE
02940
SEDATIVE FILLING
NO CHARGE
02950
CROWN BUILDUP, INCLUDING ANY PINS
NO CHARGE
02951
PIN RETENTION ` PER TOOTH,
IN ADDITION TO RESTORATION
NO CHARGE
02952
CAST POST AND CORE IN ADDITION TO CROWN
NO CHARGE
02953
CAST POST AS PART OF CROWN
NO CHARGE
02954
PREFABRICATED POST AND CORE I' ADDITION TO CROWN
NO CHARGE
'CHEDULE OF BENEFITS AND C PA ENTS
CITE' OF SANTA AAA
CLINT #I
R C
C PA
CODE
MEMBER SERVICES.
MEMBER PA.'S.
END ICS :
03110
PULP CAP - DIRECT (EXCLUDING FINAL RESTORATION)
NO CHARGE
03120
PULP CAP - INDIRECT (EXCLUDING FINAL RESTORATION)
NO CHARGE
03220
THERAPEUTIC P LP T MY EXCL. FINAL. RESTORATION)
NO CHARGE
03310
ANTERIOR (EXCLUDING FINAL RESTORATION)
NO CHARGE
03320
BICUSPID (EXCLUDING FINAL RES'T'ORATION)
NO CHARGE
03410
APIC ECT MY (PER TOOTH) - FIRST ROOT
NO CHARGE
03411
APIC ECT M (PER TOOTH) - EACH ADDITIONAL ROOT
NO CHARGE
03430
RETROGRADE SLING - PER ROOT
NO CHARGE
03940
RECAL.CIFICATI ON
NO CHARGE
PERIODONTICS:
04210
GINGIVECT MY OR GIN IV PL.AST ' PER QUADRANT
NO CHARGE
04220
GINGIVAL CURETTAGE
NO CHARGE
04260
OSSEOUS SURGERY (INCLUDING FLAP ENTRY
AND CLOSURE) i PER QUADRANT
NO CHARGE
04330
OCCLUSAL ADJUSTMENT t PER OUADRANT
NO CHARGE
04331
OCCLUSAL ADJUSTMENT COMPLETE
NO CHARGE
04341
PERIODONTAL SCALING AND ROOT PLANING - PER QUAD.
NO CHARGE
04345
PERIODONTAL SCALING PERFORMED IN THE PRESENCE OF
GINGIVAL INFLAMMATION
NO CHARGE
04910
PERIODONTAL MMNTENANCE PROCEDURE
NO CHARGE
04930
PERIODONTAL ABSCESS
NO CHARGE
PROSTHETICS.
0110
COMPLETE TAPPER DENTURE
NO CHARGE
05120
COMPLETE LEER DENTURE
NO CHARGE
05130
]IMMEDIATE UPPER DENTURE
NO CHARGE
05140
IMMEDIATE TE LOWER DENTURE
NO CHARGE
05211
UPPER PARTIAL ACRYLIC BASE
(INCLUDES ANY CONVENTIONAL CLASPS AND RESTS)
NO CHARGE
05212
LOWER PARTIAL ACRYLIC BASE
(INCLUDES ANY CONVENTIONAL CLASPS AND RESTS)
NO CHARGE
05213
UPPER PARTIAL - PREDOMINANTLY BASE OAST BASE WITH ACRYLIC
SADDLES (INCLUDING ANY CONVENTIONAL CLASPS AND RESTS)
NO CHANCE
05214
LOWER PARTIAL F PREDOMINANTLY BASE CAST BASE WITH ACRYLIC
SADDLES (INCLUDING ING ANY CONVENTIONAL CLASPS AND RESTS)
NO CHARGE
-jCDIL BENEFITS AND CPj, 5
CITY OF SANTA i A A,
CLIENT #1
COPAYMENT
PC
CODE
MEMBER SERVICES: MEMBER PAYS:
PROSTHETICS CONTINUED.,
05410
ADJUST CmPL,ETE DENTURE - UPPER
NO CHARGE
05411
ADJUST COMPLETE DENTURE - LOWER
NO CHARGE
05421
ADJUST PARTIAL DENTURE - UPPER
NO CHARGE
05422
ADJUST PARTIAL DENTURE } LOVER
NO CHARGE
05510
REPAIR BROKEN COMPLETE DENTURE BASE
NO CHARGE
05520
REPLACE MISSING OR BROKEN TEETH -
NO CHARGE
COMPLETE DENTURE (EACH TOOTH)
NO CHARGE
05610
REPAIR RESIN ACRYLIC SADDLE OR BASE
NO CHARGE
05620
REPAIR CAST FRAMEWORK
NO CHARGE
05630
REPAIR OR REPLACE BROKEN CLASP
NO CHARGE
05640
REPLACE BROKEN TEETH - PER TOOTH
NO CHARGE
05650
ADD TOOTH TO EXISTING PARTIAL DENTURE
NO CHARGE
05660
ADD CLASP TO EXISTING PARTIAL DENTURE
NO CHARGE
05710
REBASE COMPLETE UPPER DENTURE
NO CHARGE
05711
REBASE C OMPLETE LOWER ER DENTURE
NO CHARGE
05720
REBASE PARTIAL UPPER DENTURE
NO CHARGE
05721
REBASE PARTIAL L IA ER DEERE
NO CHARGE
05730
RELINE COMPLETE UPPER DENTURE CHASIDE
NO CAGE
05731
RELU�E COMPLETE LOWER DENTURE CHAIRSI E
NO CHARGE
05740
RELINE UPPER PARTIAL DENTURE (LABORATORY)
NO CHARGE
05741
RELINE L NNTR PARTIAL DENTURE (LABORATORY)
NO CHARGE
05820
STA 'PLATE DENTURE (UPPER)
NO CHARGE
05821
STAYPLATE DENTURE (LOWER)
NO CHARGE
05850
TISSUE CONDITIONING } PER DENTURE UNIT
NO CHARGE
ORAL SURGERY:
07110
SINGLE TOOTH
NO CHARGE
07120
EACH ADDITIONAL TOOTH
NO CHARGE
07210
SURGICAL. REMOVAL OF ERUPTED TOOTH REQUIRING
ELEVATION OF MUCOPERIOSTEAL FLAP AND REMOVAL
F BONE AND/OR R SECTION OF TOOTH
NO CHARGE
07220
REMOVAL OF IMPACTED TOOTH - SOFT TISSUE
NO CHARGE
07230
REMOVAL OF IMPACTED TOOTH - PARTIAL BONY
NO CILARGE
07240
REMOVAL OF IMPACTED TOOTH - COMPLETE BONY
NO CHARGE
07285
BIOPSY OF ORAL TISSUE - LARD
NO CHARGE
07286
BIOPSY OF ORAL TISSUE - SOFT
NO CHARGE
07310
ALE PLASTY IN CONJUNCTION WITH EXTRACTIONS - PER QUAD.
NO CHARGE
07320
ALEPL.ASTY NOT IN CONJUNCTION WITH EXTRACTIONS - PER QUAD.
NO CHARGE
07960
FRENECTDMY
NO CHARGE
r
,CDUL BENEFITS ANNA CA "'�
CITY OF SANTA ASIA
CLIENT #41
PARTS BANDED CASE - ADULT 500.00
PARTS BANDED CASE - CHILD 500.00
C BAYMEN7
PRO C
CODE
MEMBER LACES:
MEMBER PA'S'S.
ADUNCTIE GENERAL SERVICES:
09110
PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAID
MINOR PROCEDURES
NO CHARGE
09215
LOCAL ANESTHESIA
NO CHARGE
CONSULTATION - PER SESSION
NO CHARGE
09440
OFFICE VISIT - AFFER WORKING HOURS
NO CHARGE
BROKEN APPOINTMENT (LESS THAN 24-HOUR NOTICE)
NO CHARGE
ORTHODONTICS:
FULL. BANDED CASE - ADULT
1000.00
08000
FULL. BANDED CASE - CHILD
1000.00
PARTS BANDED CASE - ADULT 500.00
PARTS BANDED CASE - CHILD 500.00
i
LIMITATIONS
Dentures: (full or artia : e .tures r app lances �iil e replaced only after 3
etu p
have elapsed following are prior provision o such dentures if appliances
Years p p
under any Safe and program., Replacements will e made only if the existing
ud .� ,p
denture pp
or appliance is unsatisfactory and cannot e made satisfactory.
2. Denture Refines} Twice a year.
3. Prophylaxis: once every six months.
4. Full mouth x-rays: once initially and Hereafter when diagnostically necessary.
5, Fluoride Treatment; once every 6 months to age 18.
6. Reimbursement shall not be made for the cost of services secured from any other
authorized � �r�t�r�
health care provider other than the member's Provider, unless g
by Safeguard,
7. Crowns or replacement of missing teeth mith complete or partial dentures or fixed
bridges are provided using standard procedures.
CA 4/91
EXCLUSIONS
S
Any treatment requested or appliances rude which are either not necessar F for
maintaining or improving dental health, or are for cosmetic purposes -unless
o henvise covered as a benefit
2. Any inpatient/ outpatient hospital charges of any kind including dentist and/or
physician charges.
3. General anesthesia.
4. Replacement of lost or stolen dentures, appliances or bridgework.
5. Treatment of malignancies, cysts and neoplasms.
6. Procedures, appliances, or restorations to correct congenital, developmental or
medically induced dental disorders, including, but not limited to, treatment of
n yo xnctio al, n yoskeletal, or temporornandi ular joint dysfunctions unless
otherwise covered as an orthodontic benefit.
'. Implants.
8. Dental treatment started prior to the member's eligibility under this Plan or after
member's termination.
Any dental ' procedure unable to be performed in the dental office because of the
general health and physical limits of the member, including but not limited to
physical or emotional resistance or allergy to all commonly utilized local
anesthetics; extremely contagious diseases which night endanger the staff and
patients of a typical general dentistry office and severe medical problems which
would make dental therapy at a typical general dentistry office unwise.
o. Whose procedures requiring fixed prostodontie restorations which are necessary for
complete oral rehabilitation or reconstruction.
11. Any. procedure not specifically listed as a covered benefit is available on fee -for.
service basis.
CA 4/91
Orthodontic treatment is subject to the olloNNin :
A. Orthodontic treatment must be provided b a member of the Plan's orthodontic
�
panel.
B. Plan benefits cover 24 months of active usual and customary orthodontic treatment
and an additional 24 months of retention. Treatment that extends beyond such time
periods will be subject to a per-office-visit charge of $25.00.
C. 'he fol1mving are not included as an orthodontic benefit:
1. Diagnostic Records:
a. Cephalometric -rays and other -rays if needed;
b. Diagnostic tracings of cephalometr c -rays;
C. photographs;
d. Study models;
2. Replacement or repair of lost or broken appliances;
3. Retreatent of orthodontic cases;
4. Treatment in progress at inception of eligibility;
5. Changes In treatment necessitated by an accident;
6. orthodontic treatment that involves:
a. Ma llo- facial surgery, m ofunctional therapy, cleft palate, n c 'ognathia,
nacrogiossia
b. Surgically exposing impacted teeth (maxillary cuspids); C. Hormonal imbalances or other factors causing growth a developmental
abnormalities; .
d. Treatment related to temporomandibular joint disturbances;
e. Lingually placed direct bonded appliances and arch wires (invisible
braces).
f. Functional appliances that are used in conjunction with fixed appliances,
g. First Phase treatment, defined as any orthodontic treatment that occurs
hale deciduous primary or baby teeth are still in the mouth.
D. Should a member terminate from the Plan for any reason and at that time be
receiving orthodontic treatment, the member and not Safeguard shall be responsible
for payment of the balance due for treatment performed after termination, The
p ' , .� $2,050.00 ecludin members a anent shall be based upon a m�mum copa meat o g
p r of months to
an charges for diagnostic records, shall be prorated over the number
completion of active treatment, and be payable on such terms and conditions as are
arranged between the member and the orthodontist.
E. The retention phase of treatment, if required, shall include the construction,
la em nt and adjustment o retainers, the rmammur�n cost o which shalt not exceed
2o.00.
F. If a member does not require treatment or chooses not to Mart treatment after the
participating rovider has completed a diagnosis and consultation, the member will
be charged a consultation fee o $25.00 in addition to the fees for such diagnostic
records.
CA 4/91
The following Safeguard administrative policies are are integral part of this Plan and are
consistent with the principles of accepted dental practice and the continued maintenance
of good dental health:
A. TREATMENT PLANNING
Safeguard's objective is to see that all members are brought to a good level of oral
health and that this level is maintained. To achieve this objective, careful treatment
planning is required. Safeguard has established the following treatment priorities:
1. riorit F attention i's given to those procedures that, if not done first, could have
an immediate effect upon the member's overall oral health.
2. Priority is next given to treatment for active dental decay and periodontal
problems that would not have an i=ediate effect on the member's oral health.
3. Priority is then given to replacement of missing teeth.
�Xceptions may be made to this treatment planning concept based upon individual
circumstances.
B. DEFINITIONS
1. Full -Mouth Rehabilitation - is a treatment concept which has many different
definitions, depending upon the discipline of dentistry. For purposes of this
Flan, it shall be defined as extensive restorative treatment that involves 10 or
more posterior teeth and that is accomplished according to sound anatomic and
physiological concepts.
2. Correction of occlusion - Selective equilibration of the dentition or
restorations, not to include treatment of fall -mouth occlusal dysfunction.
3, optional Treatment Fee - The fee charged for services performed when the
member chooses an optional treatment plan as opposed to the dentist's
recommended customar , treatment plan. This fee is equal to the optional
treatment plan's UCR fee less a treatment credit.
UCR Fee - The dentist's usual fee for the treatment being performed
Treatment Credit -`the customary treatment plan UCR fee, less the copa ment
for the customary treatment plan.
For example:
Optional Treatment UCR Fee -- $L000.00
Customary Treatment UCR Fee 500.00
Co payment (100.00)
Treatment Credit 400.00
Optional Treatment Fee $ 600.00
CA x/91
.--JMINI STRAXIVE POLICIES (Conttued)
C. OPTIONAL TREATMENT
In
rendering dental care, the dentist and the patient frequently consider possible
optional treatment plans.
In those instances where the member er selects a optional treatment plan a opp ose
to that dental treatment plan which is customarily provided, the cost or such optional
treatment will be based upon the Provider usual and customary fee. A� credit for the
fee o p y the procedure customarily provided vill be allowed towards the fee fo r sueb
optional treatment. For example:
1. Partial Dentures
a. If a standard cast chrome partial l denture will restore function, the Provider
will allow a treatment credit toward the cost of a more complicated
recision appliance which the member and Provider may choose to use.
. A removable cast artial for patients under the age of 1 is considered
p optional �
treatment. treatment credit ill be allowed for ace
a p
maintainer.
2. Fixed Bridges
a, A fixed bridge in any posterior quadrant, v en the abutment teeth are
denta.11X sound and would be crowned only for the purpose of supporting a
i
pontic, is considered optional treatment. treatment credit will be allowed
for -a partial denture.
. Replacement of missing anterior teeth with a fixed bridge is considered the
•
treatment of choice, provided dental conditions perrmt.
c. A fixed bridge for patients under the age of 16 is considered optional
treatment. A treatment credit will be alloyed for a space maintainer.
3# Fillings and Crowns
. If a tooth can be adequately restored using amalgam or composite
restorations, any other type of restoration, such as a crown, is considered
optional treatment. A treatment credit will be allowed for filling.
. A. porcelain, porcelain fused to metal, or plastic processed to metal crown
for patients under the age of 1 is considered optional treatment.
p t .
treatment credit will e allowed for any acrylic or stainless steel crown,
CA 4/91
DENTIST DIRECTORY
SAFEGUARD HEALTH PLA,P*'Pq"
DENTAL PROVIDERS FOR THE EMPLJYEES OF
CITY OF SANTA ANA
PLEASE READ THE FOLLOWING INFORMATION O YOU KNOW O FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.
California
ARCADIA
ER
BELLFLOWER
AGOURA HILL
004404 DIENTA . CENT13R or ARCADIA
004414
ABSOLu DF, 'r L CROUP
10144 AGOURA DENTAL AL. GROUP
.JACK D. SCHULMAN, DOS
9951 ARTE S [A PLACE
5601 KANAN ROAD
75 N, SANTA ANITA A E.
S E LLFLOW ER, GA 90706
AGOURA HILLS, GA 91301
ARGAD1A, CA 91006
(310) 920 -8324 (3 DENTISTS}
(818)991-9852(l DENTIST)
(818)447-5126(l DENTIST)
BERKELEY
ALL O VI E C
004450 W1. 1,L) ANN R- HOUSTON. D DS
000294
RIC HARD L&NI OTHE DDS
110237 ROBERT F. NiURRAY. 1) DS
1235 W. 1' UNTIN T N DRIVE
2 320 WO OLS EY ST R E ET
15 MARE BL , SUITE 320
SUITE A
SUITE 312
ALI OVIEJO, CA 92656
ARCADIA, CA 91007
BEFt KEL EY, CA 94705
(714) 831 --4655 (2 DENTISTS)
(818) 449-6531 (1 DENTIST)
(510) 845 -8524 ( 1 D ENTI T)
ALTA L MA
ARTE IA
*004427
DEN -ISE ALE 'DER, DDS
110807 CALI FDR'1ADEWALC.R0UP
000132 SOIE ffWA ONG, DDS. INC
2522 DANA STREET
9330 BASELINE ROAD
i7goo S PIONEER BLVD
BERKELEY, CA 94704
SUITE #101
ARTE SIA, CA 9D701
(510)48$ - 1813(1 DENTIST)
AL_TA LO MA, CA 91701
(310)860-9612(1 DENTIST)
(714) 94v -�� ( DE#+�TISTS)
BBBEVERLY ��946-0024
008441 j\,-ro u o F AGRA DMD INC
909631
STENTN N1 GO LOYDDS
ANAHEIM
17613 PIONEER BLVD
435 N. BEDFORD DR.
000520 ONV�JUNT 'DEt \v`AL CEWE R
ART ESIA, CA 90701
SUITE 306
601 S. EUCLID AVENUE
( 13) 808-- 8482 (4 DENTIST}
8EVE RLY H ILL , CA 90210
ANAHEIM, CA 92802
(310) 550-1511 ( 1 DENTIST)
(714) 778 -8822 (4 DENTISTS)
BAKERSFIELD
110802 BAKER FIBLD DENTAL AL ROUP
000787
joH r omiovAT DDS
000667 } %'IA I tAR INIISTRYDDS
1512 NILES STREET
2411/2 S. 13 EV E A LY DRIVE
EAMILY0E NTI STRY
BAKE RSF1 ELD, CA 93305
SUITE :2000
303 N. EAST STREET -#1
(8051326-0766(2 DENTISTS)
8 EVE RL.Y HILLS, CA 90212
A fAH EIM, GA 92805
(310) 278 -8537 (2 DENTISTS)
(714)772-0770(l DENTIST)
BALD VI i PAR
004261 F&%iiLv'DnrgrjsTRy
BREA
004283 RDMIN S. GAZ$1. DDS
HARPBEET S1NG H GI E. L, DDS
000036
VAUGH ' G S` EWART DDS INC
3028 W. BALL. ROAD
14607 RAMC A BLVD., SUITE B
2500 E. IMPERIAL HWY
ANAH EIM, CA 92604
SAL DWI N PARK, DA 91706
SUITE 16
(714)82$-6331 (1 DENTIST)
(818)960-5108(l DENTIST)
B REA, GA 92621
(714)529-5920(l DENTIST)
004311 NEIL WIL NSKY. DDS.
*005499 PRAKAS PATEL. DDS.
2207 S. HARBOR BLVD
4136 N. MAIN #N3
BURBANK
ANA H EI , CA 92802
BAL DWI N PARK, CA 91706
*004474
JOIIIN Y13KIKIAN. DDS
(714) 971 -7800 (3 DENTISTS)
(8i8) 960 -6395 (1 DENTIST)
303 S. GLEMOAKS BLVD,
SUITE #7
110153 TRUC TRONG LIE DTL CORP
BANNING
B U R BANK, CA 91 02
637 N. EUCLID STREET
*000559 PASS F INiILYDEN- rISTRY
(818)843 -7841 (2 DENTISTS)
A ?AHEIM, CA 92801
4240W. RAMSEY
(714) 772 -2893 (3 DE TIST)
BAN N €Nfi, A 92220
O Ai�IL�.
(714) 549- 4484 ( 3 D E NT1 TS)
004273
GINA T IRGE RS ', DD
APTOS
484 MOBIL AVENUE
004832 Tf10,N1SS3. lILLI ON. D.NID
SELL
SUITE
3275 APTOS RANCHO ROAD
000033 NICHOLAS BITAR DDS
GAMARILLO. GA 9 010
SUITE #C
6334 ATLANTIC BLVD
(8€5)484 -1221 (1 DENTIST)
APTD , CA 95003
BELL., CA 9D201
(408) 686-1997 (1 DENTIST)
(213) 550 -3646 (3 DENTISTS)
114556
FARM SRULATI, D.D.S.
484 M0131L AVENUE
ARCADIA
BELLFLOWER
SUITE 3
000120 ARCADIA DIBNrAL CROUP
000040 L 'C B AC14 DE 7I STRY
DAMARILLO, GA 9301 1
DAVID ELLY,ADDS
17238DOWNE BL,VD.
(805)482- 9868(1DENT1 T)
111 E. LIVE OAK AVENUE
BELLFLO ER, G / 90706
ARCADIA, GA 91006
(310) 531-02 1 (2 DENTISTS)
CAMPBELL
(818) 445 - 1181(4 D E NT1 STS)
*000266
SAN TOM AS DENTAL GRO UP
000489 J I'G I-1 1< UN DDS
484 W. HAW LTON AVENUE
000257 8 RAVIIN'DRANDDS
BELLFLOWER 0 ENTISTRY
CAMPBELL, CA 90400
611 SOUTH FIRST AVENUE
17419 SELLFL WER BLVD
(508)378 - 2890(1 DENTIST)
ARCADIA, GA 91006
BELLFLOWER, CA 9 706
(818)445-0678(l DENTIST)
(310) 804 -1307 (1 DENTIST)
10109192 PAIGE 1
Please choose one of the above participating Safeguard providers by entering the appropriate provider number on your enrollment card.
Safeguard reserves the right to transfer a member to the nearest provider faclilty if the Safeguard provider facility receives are Insuf#1cient
enrollment, or Is no longer an active Safeguard provider. The above listed doctors with an * are no longer open to new enrollees.
SAFEGUARD HEALTH PLA `P'�
DENTAL ?ROVIDERS TY OF SANTA ANA EMPLJYEES OF
PLEASE
READ THE FOLLOWING INFOR MATION SO YOU KNOW FROM +lH M OR WHAT GROUP OF PROVIDERS HEALTH CARE MANY 13E OBTAINED.
CANOGA PARK
HIND HILLS
CONCORD
099881 NXNA K ODHIN41 ITS
1 10599 PIERRE F. FIR TALI O. DDS
000757 comN3iJNin' T)ELN f'At cEINTE RS
399 TOPAN G A CANYON BLVD
M [LAG ROS CASTAN E DA, DMD
5161 CLAYTON ROAD
14652 PIPELINE "ENUE
CONCORD, CA 94521
SUITE 202
CAN 0GA PAR K, CAS 91304
CHINO HILLS, CA 91709
(10) 682 --8566 (2 D ENTIST )
(818) 704 -4822 ( 1 DENTIST)
(714) 393 -5501 (2 DENTISTS)
CORONA
HULAS VISTA
*095459 3UFFREV I NS P K'TOR. DDS
005483 DONTALD PAR,N'i7iNN. DOS
000D79 Wi1,Ll&SI AS 1AF1 E LD jRDDS
441 SOUTH Lt CCLN AVENUE
22323 S HE RM AN WAY
230 F STREET
SUITE D
SUITE 419 -20
SUITE D
CORONA. CA 91720
CAN 0 G PARK, CA 91303
CHULA VISTA, CA 92010
(714)736-1822(l DENTIST)
(9 1&) 884 -8110 (2 D ENTtST)
(6 19) 427=5252 1. 7 pEIVT1STS)
COSTA MA
CANYON COUNTRY
000496 STE PHEN AL TAYLOR DDS
000249 ALBIERT I, SUKUr DDS
009744 RICUARD FER A DEZ DDS
61 THIRD AVENUE
2900 BRISTOL, BLDG. C
16608 SOLE DAD CANYON ROAD
SUITE 102
CANYON CO U NTF Y, CA 91361
CHULA VISTA, CA 9201E
COSTA MESA, CA 92626
DENTIST)
(805)251-0480(l
( 19) 425 -7700 ( DENTISTS)
(71) 540-6852 ( 2 D ENTtSTS)
CARSON
004382 CHULA VISTA DTL OFFICE
ISRAEL ISI�+?.�, DDS
��4 i,REi�E ,I. SKETCH. DDS.
()00 N'11I�ATsL �iLI�O�'. DDS
265 E STREET
2850 MESA VERDE DRIVE
WISE DENTISTRY
CH U LA VISTA, CA 92010
SUITE K
550 E. CARSON STREET
(619) 4r+1- -9f39(� ( 2 D E#+��`IT)
C{�Tf� MESA, CA 92828
OS
CARSON, CA 9075
(714)546-3230(1 DENTIST)
(10) $3 -884 ( 1 DENTIST)
004429 SPECrRUIAI DT'`L REALTH CTR
LYNN 11h5, D D
�0'1 #RAD ��IIf, bi5
*00€8 CHARLES ADERS �I! DDS
'
345 7- STREET, SEIITE 14
CALIFDRtwJ1A DNTt- ACCIATES
20401 LON
CH�.1LA VISTA, C14 J191Ei
1755 D RANGE AVE., SUIT I- D
SUITE A
(63) 47B -1E�01 {3 �]EkTlSTS)
COSTA �CSf�, 0492827
CARSON, CA 9074
(71 ) �O4B -9671 ( 1 DENTIST)
(310)538-2263 (1 DENTIN`)
005489 GEORGE JARED DDS
COVINA
110345 EUU RDO M. GAiwir '. DDS
290 -- B LANDS
CIitDLAlItS"FA, CA92I�1Q
0�0 �O:�ih�illTT`i' DE'�'rif. C�`�'I�RS
22012 S. �4ALON BLVD.
(19j 6���1� � t D�iTtST}
1052 N. CITRUS
�
CARSON, C 90745
COVI NA, CA 91722
(310) 64-696 (3 DENTISTS)
' 1 10322 PROFESS I 0 L DT'L GRP
(813) 915 -5343 (3 DENTISTS)
CENTURY ITT
301 THIRD AVENUE
C�-'� HULA VISTA, CA 92I�1E�
�`����� RElDI` Lf3Y� *�i. DDS.
00020 l3�iRft�' I�ASHFi�'. DNfll
���9��7I� -14��� DENTIST)
109.ORAt�tDVIEA1fE.
2080 CE 'TURY PARK EAST
COVINA, CA 917"23
E NTU RY CITY, CA 90067
�.TiV
(81) 331-1201 (1 DEI�#TISTJ
(310) 553-1678 � DENT�TS�
X004375 LA CADENA DENVAL OFFICE
lT'�
ERRI�'
405 NORTH LA ADE�fA DRIVE
O�T�442 Cl�RRiT1S DI�'!`AL CE'�'l
CDLT�Iht, Ef�4 9232
X00589 ASE B�LL�.DD
000569
WARREN E. �AFfANt DDS
1135 183RD STREET
(714)82$- 156(1 DENTISTS
10714 WASHINGTON BLVD.
CERRITO t CA 90701
(310) a60- -03$7 ( 5 DENTISTS}
*0D4�� S"�'P1��'RtCI�IIEI�'�`�i�.Li'iC
CL�IERCIT,C�i90230
( 31 � 638 -7780 ( 2 €�E TI TS)
�/�;
J■
420E E. WASH INYTON ST
HA►T WORTH
SUITE F -2
CYPRESS
0 ()()i3 R0B1RRT CLEY,�'fAFTDDS
COLTON, CA 92324
(714) 422 -0685 (2 D ENTI T)
000824 `YPRT, DENTAL GROUP
10230 CANOGiA, SUITE 1
9922WALI ER STREET
CHATSW RTH, CA 91311
i�IPTi�
SUITES C1 -- C2 & D
(818) 882 -5 ( 1 DEt�7IST)
000029 S11AILES11 PAPdKILUDS
C PRES , CA 92630
CHINO
20-01 E. CO iPTON BLVD.
(714) 220 -0354 (2 DENTISTS)
*000 }19 A, -%-DRS �' I WO G DDS
COMPTON, CA 90221
DAL1IT
1132 N CENTRAL
(310) 639-7970 (1 pEiTkT}
0007 A' FON IS ON DDS
CHINO, CA 51710
{71 ) 52785 1 ( DE#'IT�STS
005385 I)R. PATEL' FAINT DTI, GTR
901 CAMPUS DRIVE
1315 N BULLIS
SEMITE 3304
SUITE #3
DALY CITY, CA 94015
*000225 AN7140NI D KAVORINOS DDS
(415) 756 -1900 (1 DENTIST)
12604 CENTRAL AVENUE
CO1 PTO , CA 91 221
EL CENTRAL REAL PLAZA
(310) 639 -5330 ( 1 DENTIST)
CHINO, CA 9171
(714) 591-1745 (4 DENTISTS)
10109192 PAG E
Please choose one of the above participating Safeguard providers by entering the appropriate provider number on your enrollment card.
Safeguard reserves the right to transfer a member to the nearest provider facility if the Safeguard provider faclitty receiv % att In uff1 lent
enrollment, or is no longer an active Safeguard provider. The above listed doctors with an * are no longer open to new enrollees.
SAFEGUARD HEALTH PLAT "'
: . DENTAL dROVIDERS CITY OF SANTA TH MPL.�YEES OF
PLEAS R EAD THE FOLLOW
I NG I N FOR MATIO SCE YOU KNOW FR OM WHOM OR WHAT GR OUP OF PROVI DERS H EALTH CARE MAY BE OBTA R N ED.
10109/92 PAGE
above participating Safeguard providers b enterin the appropriate provider number n your enrollment card.
Pease choose one of #b � P
ri ht t transfer a member to the nearest pr eider faculty If the Safeguard pr vIder faculty reeelves an insuffl feint
safeguard reserves the g
i n g
enrollment, o longer an active Safeguard provider. The above 11 ted doctors w1th an * are no longer open to new enrollees.
�'
EAST LOS ANGELES
EL TORO
DALY CITY
000653 DAVID HAMBURG. fib
404288 DAVID HAGGARD, DDS
000438 CHARLES A MURILLO DDS
.
21991 EL TORO ROAD
BART CITY DA
NEAR �.CITY
45 S, KERN AVENUE
EL To�O. GA 9GS0
2171 JUNIPER ERRABLVD.,
EASE`LOS ANGELE ,OA 9002
(714) 380 -7788 ( I DE TI T)
DAL`F' CITY, DA 94015
(213) 263 --2126 (3 D ENTt TS)
(415)9s-04a0 (3 D ENT1STS)
E1N
000783 M YON# WON 7O L DD
❑ �IriA
4736 E,WHIMER BLVD.
000962 jjAnFsf3 `CIRWA.RTDMD
EAST LOS ANGELES. GA 90022
SHARON SAYE, 1) D
005443 € EL A I A R PROFESS IONAL. RP
288 -3395 { DENTISTS)
15726 VENTURA BLVD., 300
DRS. BALE AND FARAJADEH, DDi)
E N C1 NO, CA 91436
1398 MAO DI $!104
000780 LLONT E. S'TOLL. DD
--
X818) 788 6864 (4 O E f T1STS)
DEL MAR, CA 92014
WHITE 1A E MVl1L YE 0. PROF. SLaL
(615) i 2`16 62 (} D E NTI} 7)
710 BROOKLYN AVENUE
110353 PRO IO 'AL DTL CARE
DIAMOND BAi
EAST LOS A ELES, CA 90033
16573 VENTURA 8LVD., S UITE F
1213) 268 -18€15 (2 DENTISTS)
ENCINO, GA 91436
000424 ANGELA SAMAA- W) S
(8 I8) 601-6400 (4 D E TCSTS)
750 N. DrAMOD BA R B LVD .
BATE �$
04331 B�'I..F HEI�EI'F` �'AA'flLl' DTI.
ESCONDID
D A 917
pIAr�lOr�� BAR, OA 5765
D
21�� i12 BROOISL1�t� ASE �1
EAST LOS ANN E LES. OA 90033
004423 SPECTR DT1, IIEA�,.TH CTR
th) 860-3111
(213)268 - 8308(1 DENTIST)
LYNN SIMMS, DDS
11141 . VALLEY PARKWAY
DOWNEY
i
00 'I'EVL K. �rl
E OND100 OA 92025
'
00002 I"A�'�IL�'DE'I'AL E'I'SR
#DF]
4777 E. ISHER ST,
I`
(613)736-1070 ( DE"TiTS)
1050 LAKEWOOD BLVD
,}k�t�E
SUITE A
PAST r,ro5 ii#�C.�L E. G 90022
*110321 T,�'rii�il� F. SIHEPARD. DDS
E1 t E12 �
(213) 267 --1343 (1 DE NT [ST)
8 NORTH ESCONDIDO AVENUE
(310) $87 -2341 (3 DIE NTI TS)
EL CAJON
EscoN 01D0, CA 92025
X000284 A, -rIim ' ADAM DD S
(619) 743 -1516 ( 3 D ENTISTS)
004295 P.O. SHAIL DDS
1252 BROADWAY, SUITE B
8029 EAST IMPERIAL HWV
EUREKA
DOS+ N E`E*, A 90242
EL DAJ�Ihlx 92�12i
(619) 440 -0876 ( 2 D ENTIST )
004460 JAMES L. F 'IT. DDS
(310) 062 --6379 (2 DErVTl 75)
618 HARRIS STREET
004485 IJUC. J. UIST.�+DTDgS
005289 �,.i -rH �F!' -P AROFALD D M
#��/�
EUREKA= A 95501
(707) 442- 1763 (1 DENTIST)
8221 Er THIRD V #i7EET
O
742 �#,RrVI`iD/Y�YfI�"i}y+��j�j
��. #iV��i, k.+i"k.7LVL.�
I�-Is LI-L
ANA4UE
FONT
��P� E`�* A 8r��1
(1 9 ) �3A0 -0072 { 4 D E#�#TI�`S)
10280 ItRRIENDLY DENTAL E 'TER
(310)869-357,8(1 DENTIST)
11823 CHERRY AVE., SUITE B-
0 PDT *ALDI�'T`A�, BR �'IO�
FO TA A, CA 92335
DLJAI T
247 N. MAGNOLIA VENUE
(714) 356-14 8 5 (3 0E�]TISTS)
00040 P DI�OI..�rl � 'A,DD.'+
ELOAJON#92020
924 B U E A VISTA, UITE 102
X619) 444-3127 � � �EhlTISTS)
FOUNTAIN VALLEY
D ARTE, OA 910 #0
L l�l�l�1T
004328 'IARINA DE MAL ARE
(8 ig) 357 -��� { 0 Ef�Ti�')
17150 EUCLID AVENUE #308
000578 ALMD CRONG. DDS
F U TAIN VALLEY, A 92706
DUBLIN
228 PLA A PROFESSIONAL BLDG.
(714) 44-� #7 ( DETtTS)
��� D�f #l�i�tl'I'�' DF1�'i`L I�'TIS
EL GE �i#�rTO, 94530
$759 DUBLIN BLVD.
(415� 524-980 (1 DE�1Ti 7)
F EMONT
DUBLIN, OA 94568
�L �T�
000674 O,kj.Nj JIh'T T DENTAL CENTERS
(415)828-9600(1 DENTIST)
40756 GRIMMER BLVD.
400406 L'OR'I' R IN 10 -rEDTL CRP
FREMONT, OA94538
i. �
S HAM A NA OHA , DDS
(5i0) 659 -0690( 1 DENTIST)
000683 R.K. li h'. DDS
4900 PECK ROAD
2526 COLORADO BLVD.
EL �+4OTE, OA 91732
�8�0)579 -158(1 DENTIST)
*041 SAi�IIARII]�}S
EALEI{�GF�,OA9004i
380BO MARTHA AVENUE
(213) 256 --2885 (t DE TII T)
ELSEGUNDO
SUITE O
004468 CT ND)' M. CREWS. D1)S
000817 COM N1UN1W 1)ENWAL CEM FS
F R E MONT, DA 8453
(510) 796 -3913 (1 D ENTIST)
1621 COLORADO BLVD.
MAIN STREET
EAGLE ROOD., DA 90U�1
EL EO�lI]f3, OA 90245
EL
FRESNO
( 1 ) 44-048 (� D��Tl5T�
(10) 322-000 (1 DENTIST)
*000325 WILLIAM HO DDS
5492 N. PALM AVENUE
FRESNO, CA 93704
(209) 435 - 113 (2 D ENTI TS)
10109/92 PAGE
above participating Safeguard providers b enterin the appropriate provider number n your enrollment card.
Pease choose one of #b � P
ri ht t transfer a member to the nearest pr eider faculty If the Safeguard pr vIder faculty reeelves an insuffl feint
safeguard reserves the g
i n g
enrollment, o longer an active Safeguard provider. The above 11 ted doctors w1th an * are no longer open to new enrollees.
�'
SAFEGUARD HEALTH PLAT"
DENTAL 'RCIANTTY OF S A ANA EMPLoYEES OF
PLEASE READ THE FOLLOWING INFORMATION SO YOU KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY 8E OBTAINED.
FULLERTN
GRANADA HILLS
HT
900776 FULLERTON DENTAL CEN'S'ER
004335 EDWARD L. HEUNIAN DDS
004345 W1LLIA,NI S. NJALYE 2r1. DDS
3232 1 W. FLORIDA AVENUE
215 hT. HARBOR BLVD.
17050 CHATSWORTH AVE.
H E f ET, OA 92343
F U L L E RTON, CA 92632
SUITE #109
(714)652-4464(l D E TIST)
(714) 680 -6757 (2 DENTISTS)
GRANADA DILLS, CA 91344
(18)36 -090(1 QENTIST)
110379 AREA DEN7AL CENTER
*909984 TSI GHDDSINC
HACIENDA HEIGHT
640 N. x]f41�i J1`��ri1�FTLJ ST., .TE
#L' i��f'i��L �YV 1�.
�DO�f VIOLA �sKARO,�DS
�# Eh+�ET, C 92544
FLLEF�TOhI, CA 92fi�5
2440 HACIENDA BLVD,
{714 } 765 -174 ( DE#�T1STS)
(734) 73� -090 � � DETIST�
SITE 233
i..l� P�lGR
005488 OBERTW.��1 �'A114ARA.DD
HA IE DAHEIGHTS, A91745
�99�9 1�E�'�`Ai. R3l�j' � EiE�13R��i
2206 W. {�i11�OI�l�dELT� -i 1�Eh! l.� �
(15) 96 -0 0 ( 1 D E[�fiIST)
15776 MAIN STREET
��
FUL�.ERTON, CA 92633 (714)738 --5511 ( DENTISTS)
004298 AjN- 1T"ATANI.DDS
1S
3065 S HACIENDA BLVD
I'iESPE#��1, OA 9245
HESS
GARDEN GROVE
HACIENDA HEIGHTS, A91745
(5�8 }945 -8484{ E]ENTIST �
*004480 LV', P. TRAM . DDS
(813) 951 -6205 ( 1 DENTIST)
HOLLYWOOD
1027? WESTMINSTER AVENDE
HAWAIIAN GARDENS
000180 SAID ALYDDS
OAI�pEi� ROVE, CA 92643
043 HOMO YUAN' YEN. DDS
1660 N. VIDE STREET
(714)638-7940(l DENTIST}
144 SOUTH N(�RWALI� BLVD
HOLLYWO0D, CA 90028
iA DENA
HAWAt1AN GAR D EN S, CA 90716
(213)494-2033(1 DENTIST)
000435 SF -Y0U, K1,-%L DD
(310)402-4202 (1 DENTIST)
�j0 y{ p 7 -ENG * �7 D
:.fV'TI a7�� S. 1� i}J3+L31�11* �lfr3
15201 S. WESTERN AVENVE
HAWTHih1E
H 0 L LYWOOD MEDICAL TOTER
ARDEN A 9049
7006 HOLLYWOOD ��/�`.�yVO� BLVD, �'�E 817
10) 5327323 ( pEiTITS)
09099 E�`H I I SENN `-
-C+�D �By
�V�4 VLJ �t L��V�f.
JEFFREY U. LrHELJ�TEC�i 1�L�
—Yw
LENDALE
13220 AWTHOR E BLVD.
(213)466-3541 { 4 DENTIST)
*000811 WILLIAM FONG. DDS
HAWTH RNE, OA 90250
HUNriN�"�! BEACH
532 EAI�VI EI BLV D.
( 10) 79-59 ( DENTISTS)
00304 R1I2t1iD It\r ON7�ELLf Difa}
18582 BEfi'4Lrfi BLkf LJr
(818)957-7711(1 ��L'I�LT�
13439 CRENSHAW BLVD.
SUITE 220
HA +fTHOR E, CA 902 0
H TINOTDN 8EI CH, CA 92648
D00 f Iti1(3 `�.Ai l 3
(1) 644 -121 ( # DENTIBfi)
(714)962 --669 ( pNTI�3`S)
14 . BRAND BLVD+
GLENDALE, CA 9120a
(81$) 02-19 9 ( DE[�#TISTS)
990999 rt�4'1' I�A�i`�1DR.�� D'A'L OP
000858 I)ANTDOITRI TE B DD
RONAL O W. TH0MPSO , DDS
3369 RDSECRANS AVE N E
I'�Al'�[RI�lE, CA9�SQ
��6$�1fARERAV�NBE
E 79 LE }ALE E 'T ►L O1 M JP
�3� 57�- -�OI�� 2 DENTISTS)
UNTINCTON B E CH, A 92547
3899 VERDBOQ BLVD.
(714) 842 -5593 (2 0ENTISTS)
SUITE 340
O L E N DALE, CA 91208
0043 52 RICHARD A. LITINIA . DDS.
120 #�AWT�iORIE PLAZA
00088 [ R(�EI�'�3ERO. DDS
(818790 -0581 ( DENTISTS)
HAWTH0RNE_ A90251
5112 WARNER AVENUE
*004271 OA y S. FIN R, DD
(314) 544- 2238 (1 D ENTIST)
SUITE 101
H.UNTINGTON BEA H, CA 92649
6007 N. CENTRAI.AVENUE #310
HAY11I1Ai�#�
(714 )846 - 2806(1 DENTIST)
GLE# DAL , CA912 3
1818) 240 -3368 (1 DENTIST)
004453 CLELEN C. TANNER. DIDS
OQ447 R'IHURj. Al3RERA, DD
21911 FOOTHILL BLVD.
H AYWAR D, OA 94541
18542 BEACH BLVD.
I IA . DDS
004391 VAROUJ '
(51) 889 -8392 ( 1 DENTIST)
�#�NTIN,TOt+t BEACH, OA 92548
122 S. O�.EiDA�.E 11E[YE�E
(714) 965 -825 ( i 0ENT15-0
LENDALEx CA910
�8�8} SOCK -39� (2 DEh#�`ISTS�
� � 097 F9 Pl [E F. LA �IL�E, €]DS
004491 KFRRYSin'M1ZU -DD
22564 MISSION BLVD,
5132 WARNER AVENUE
iLEND RA
HAY WARD, CA 94541
SUITE #103
000137 FAMILY DEN-m, OFFICE
(510 ) 581 -1991 (2 DENTISTS)
HUNTINGTON BEACH, OA 92649
OF GLENDORAICOVINA
�IEIi�ET
(714)846-1354(l DENTIST)
419 E. Af�Ft�3 I��H1�4Y
L7��1�1 IJ i.I TI�} L.+ri ,7���V
*V 4LV �}1}ORGE �71iif�R. DD.7 INC. li�L+
GRAY.
110220 O1tA ABAL�.ERO, BIAS
(818) 914-- 888 � DENTISTS)
1031 E. LIT!- �AI�Jk
7812 WARNER AVENUE
SUITE 42
HUNTINGTON BEACH, CA 92647
005486 A LOSTA FAIN ifLY1)EN --Al, CTR
HEMET, OA 92343
(714) 848 --9200 (1 DENTIST)
WILLARD C. FISHER, D.D.S.
(714) 325 -05 38 (2 DENTIST$)
750WEST ALOSTA"E., SUITE E
GLE DORA, CA 91740
(818) 335- 5227 (2 D E[VTISTS)
10109/92 PAGE 4
Please choose one of the above participating Safeguard providers by entering the appropriate provider number on your enrollment card.
serves the ri ht to transfer a ember to the dearest provider facility if the ate uard provider faculty receives an insufficient
afgut'd re g
ent or I no longer an active Safeguard provider. The above listed doctors with an * are no longer open t never enrollees.
enrollment, g
ib SAFEGUARD HEALTH PLAT
DENTAL. �ROTY OF SANTA ANA EMPL,YEES i OF
PEAS READ THE FOLLOWING I NFORM ATl 1 BCC YOU KNOW FROM WHOM OR WHAT GROUP F PROVIDERS HEALTH CARE MAY BE OBTAINED.
HU TINGTON PARK L
LA HABRA L
LA PUEHTE
00(4 1D EVEN EI1 SIiISI i i 1
10241 ��H •DER,�AN. IDDS D
1485 IE#i ROAD
4 E. FLORENCE AVENUE i
�4
LA PENTE, 917�e4
1-� �,kTINOTC3 F'AI`il ��� L
LA �IADRF�# O 8083 L
(1 8) 917 -9308 ( 1 D ETIST)
(2131582-0755 ( D EDIT)
LA JOLLA L
LA VBRN
000756 % I ANN DENTAL CE -r9R L
000256 It AI.D E VEXERSO DDS 1
110301 ,JAMFS D. SHUNK. DMD
O R. B E NJAM IN MANAV 1 0
JOYCE A. PETER ON. DDS C
CH RI TI AkPETIT, DD
6436 RITAAVEN E J
8950 V1 L LA LA JOLL.A D R.,# 1105 1
1413 FOOTHILL BLVD., SUITE
H NTI NGTO PARK, CA 90255 8
L VERA! E, CA 91750
(213) 586-63 84 ( DENTI STS) L
LA JOLLA, CFA 92037 L
(714) 593 -7561 (1 DENTI T)
(619)455- 9614(4 DENTISTS) (
I N[ I
LAGUNA HILLS
0
0
004257 +EPE E+ IOC K O O1. D IN ID L
1 101 DRLY "I'Ai'�'.I�A
i -855 ��(�i�#1�+�AY 11� 4
4401 I�Ii]E L��ITEt L#1'�E 107
IOIC1, CA 92201 �
�il"I`E X234 4
LAGUNA HILLS, CA 92653
(619)347 -2331 ( 1 DENTIST) (
(Big)559-3050(i 1 DENTIST) {
{7 14) 586- 8110 (1 0ENTI T)
INGLEWOOD L
LAKE ELSIN R
000175 A1' L 'rI�'E DDS
� 1 0304 RB'I' pB'1',��. GROUP
�0430 AIt'rIi1JRJ, FI.3SCH'I`, DD.
CHESTER W. hAi.11µi4,llA, DDS! jl�i 4
MISSION �
3516 WEST IMPERIAL HWY. S
��� 3
SUITE
IN G LE O00, CA 90303 L
LA JOLLA, CA 92037
(6�9) v37- -S(�77 � ���T} L
LAKE ELIlC�RE, �1930
{213) 676- -6395 ( 0E NT1 T (
(714) 6744-6808 ( 1 D E TI T)
000648 NARINDER P UPPAL DDS L
LA MESA
LAKE FOREST
HILL RE T BLVD. MEDICAL CENTRE 0
000244 IDAYID N RPP DDS L
���7 ARIA IRVAI, DDS
336 E. kILlREST BLVD, ATE 11 8
���� TF�NBi�OO LOAD, SUITE 1
1�4lC1ODi A86301 L
LAM EA, A 9041 �
10109/92 PAGE
Please choose one of the
move participating Safeguard providers by entering the appropriate provider number on your enrollment card.
Safeguard reserves the rl g ht to transfer a me ber to the nearest provider facility If the Safeguard provider to IIty receives an Insuffi clent
enrollment, or i �
s no longer an active Safeguard provides'. The above Iisted doctors w11h an * are no longer open to new enrollees,
SAFEGUARD HEALTH PLAN
DENTAL ?RERS OVID OF SANTA TH AE ANEMPLJYEES OF
PLF-ASE READ THE FOLLOWING INFORMATION YOU KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CANE MAY BE OBTAINED.
000733 1oH P Am)ERS IDS
214SOUTH'H" STS EET
LOMPOC, CA 9 436
(805)736-7595(1 DENTIST)
LONG BEACH
000118 LONG BE CHnE -FAL GROUP
65 REE)OND A E.
LONG BEACH, CADS { [4
(310) 433 -0494 ( 3 D E NTISTS)
000184 JAMESCSERLESDDS
4301 ATLANTIC BLVC..
LONGS BEACH, CA 90807
J310)426-9308(1 DENTIST)
000365 ALAN ,% GRANT. DDS
+ R Ey LONG kB ROO /1�` CENTRE 1j'y B-6
LONG B EACH, CA 90807
J3 10) 426- 6455 (3 D ENTIST )
004265 PAUL M. HILLENGER. DDS
6226 SPRING STREET
SUITE #375
LONG BEACH, CA 5081
(310)425- -3315(2 DENTISTS)
*004389 JrfE ' M. V SA. DDS
TAR ED! L. 31N HAl. ODS
2558 EAST ANAL[I -1M STR EET
LONG BEACH, CA 90 04
J310) 438 -9437 ( 2 D E NTIST)
*004408 ROSIBMARiF M. CRUZ. DDS
110 W. OCEAN BLVD.
SUITE 301
LONG BEACH, CA 90S02
(310)590 - 9545(1 DENTIST}
005275 j0jjN REl - FSIN`CE . DD
3621 ATLANTIC AVE.
SUITE E
LONG BEACH, CA 90807
(310) 424 -0724 ( 1 D E NT IST)
110376 BRUCE R. BAR L, DDS
6514 E. SPRING STREET
LONG BEACH, CA 9081
(310)420- 8578(1 DENTIST)
LOS ALAMITOS
000672 A IIDIK 1E11T . DDS. INC.
10900 LOS ALAMITO BLVD.
SUITE #133
Los A€..AM ITOS, CA 90720
(310) 596- j 603;2 DENTISTS)
*000686 ALLEN A. BRO1VN DDS INC
10552 REAGAN STREET
Los ALAMITOSt CA 90720
(310)S27-2650(i DENTIST)
LOS ALAS ITO
004473 G 0PA1, R. 1' `I URO. DDS
3662 KATE LLAAVENE
SUITE 206
LOS ALAMITOS, CA 90720
(310) 598 -7914 ( 2 D CNTISTS)
LOS ANGELES
000006 IjAR],E AiOORE DDS
5517 HOLMES AVENUE
LOS ANG ELES, CA 50056
(213) 583- -491 ( 2 D E WTISTS)
000087 MLSHIRE DEN'I'AL SERVICE
BALM! SUNG. DDS
4520 WILSHIRE BLVD.
LDS AN ELES, CA 50010
(213)936-2106 (1 DENTIST)
000053 NJ 0 It L B I L LINGS L8A DDS
6001 W. MANCHESTER
SUITE 1
LDS ANC ELES, CA 50044
( 13) 753 -2361 (1 DE TI T)
000081 JAMES T BLACK DDS
3015 C R E NS HAW BLVD.
LOS ANGELES, CA 90016
(M)731 --0801 (7 DENTISTS)
000084 WILSH IE CTR DTI, GROUP
3932 WILSHIRE BLVD.
SUITE 104
LDS ANGELES, CA 90010
(213) 386- 3336 (5 D E NTIST )
000124 SHAW-ADAMS DENTAL GROUP
5220 W. WAS HIN GTON BLVD.
SUITE 103
Los ANGELES, CA 90016
(213) 933 -5641 (2 DENTISTS)
000126 sHAW-ADANIS DIE reL GROUP
42714 S. AVALON
LOS ANGELES, CA 90061
(21 3) 754 -2940 (2 D ENTISTS)
000368 R1 CIIARD'M. AB RANI S. DDS
3311 GLENDALE BLVD.
LOS AN ELES, CA 90039
(2 13) 686 -7665 (1 DENTIST)
000409 110VVA tD C RI xNI TD DDS
6200 WILS HIRE BLVD, SUITE 16€9
LOS ANGEL ES, CA 50048
(213) 937 - -2900 ( 3 DENTISTS)
000470 THEOD ORE 1) STOM E L,WNW
6317 WILSHIRE BOULEVARD
LOS AN G E L ES, CA 90046
(213) 65 --1304 ( 2 D ENTISTS)
000556 NIA LASKA. DDS
34601 1 LS HIRE GL D., SUITE 104
LOS ANGELES, CA 90010
(213)386-3348 (1 DENTI T)
LOS ANGELES
000968 RAYMONV MNIOI1 DDS
1803 SUNSET
LOS AN GEL, ES, CA 90026
1213)484-9063(1 DENTIST)
004344 T1IIEoDORI; M. B URNETT. DDS.
3756 SANTA ROSALIA DR.
SUITE #500
LOS AN GEI_.ES. CA 90006
(213)294 -7673{ 1 DENTIST)
004349 ICI G EILAN'D FAR FA-11% I DTL
5016 YORK BLVD.
LOS ANGELES, CA 90042
(713) 254 -1631 (7 DENTISTS)
004365 ADE LAIDA T Q L9 NGCO. MN ID
1127 WILSHIRE BLVD.
SUITE 1103
LOS ANG ELES, CA 90017
(213)250- 3558(1 DENTIST)
004402 CULVER DEL RUV DTI, OFF
PAUL B. PALER, DDS
12756 WAS H I N GTO N BLVD.
LOS NGELE , CA90066
(213)306-7088(l DENTIST)
*004467 SHAH -o LEE. DDS
536 8, ALVARADO ST€IE ET
LDS ANGELES. CA 50006
(213)380 - 1996(1 DENTIST)
004496 BASSMTE A. CAYASS0. DDS
1839 W. IMPERIAL H1 Y
LOS AN 6 ELES, CA 90017
(213)757 -1761 (1 DENTIST)
005444 H013ERT C. RITTEL. DDS
FAMILY DENTISTRY
15491. OLYM PIC BLVD.
Los ANGELES, CA 50015
(213) 380 --1664 (3 DENTISTS)
005487 C INNA F. 'A]GAiO, DNID
3876 W1 LSHIRE BLVD
SUITE 1204
LOS ANGELES, CA 900I D
(213) 381- 3312 ( 1 D E#TIST)
110392 PERSONAL DENTAL ONCE
(3222 WILSHIRE BLVD.
LOS ANGELES. CA 90048
(213) 9'33-4444 (4 DENTISTS)
MANTECA
000308 LLOYD M. HENRY. DDS
MAi TECA DENTAL GROUP
-132 SYCAMORE PO BOX 1103
MANTECA, CA 95336
(709) 823 #2164 (3 DENTISTS)
10/09/92 PAG
Please cheese one of the above partlelpatIng Safeguard providers by entering the appropriate provider number on your enrollment card.
Safeguard reserves the right
to transfer a member to the nearest provider facility if the Safeguard provider facility re elves an Ins>ufflolent
enrollment, or Is r< g o longer an active Safeguard provider. The above listed dootors with an * are no longer open to new enrollees.
SAFEGUARD HEALTH PLAT FOR DENTAL rROTYDOF SANERSTA ANA EMPLOYEES OF
PLEASE READ THE FOLLOWING
INFORMATION YOU KNOW FROM Wli M OR WHAT GROUP OF PROVIDERS HEALTH CAFE MAY BE OBTAINED.
MENLO PARK
000742 A, rD E SOBl RSK I DS
1300 UN IVERSITY DRIVE
SUITE 7 p
GENLOPARK, CA 94025
(415) 325 -1319 ( 1 DENTIST)
MILPITAS
004750 USHA O. SHAH. DDS
371 JACKLIN ROAD
MILPITA , CA 96035
(408)263-2752(1 DENTIST)
MISSION VIEJO
*004266 CAL -DE MAL GROUP
25542 JERIMENO
SUITE 43
MIS ION VI EJD, CA 92691
(714) 786 -5038 (2 DEINIT[STS)
MOD ST
*004472 DONALD L. HILLOCK, DDS
2020 ST NDIFO€ D
#SITE ,# -2
MODESTO, OA 95350
(209)622-8800(l DENTIST)
11()558 �1 HE Y DEN'I`M.. CROUP
140 MC H. EN RY AVENUE, SUITE 42
MODBSTO, CA 95354
(209)577-5008(1 DENTIST)
11 ONT LAI
004275 R. M. MULCHANDA 1. DDS
E. JOHNSON, DDS
9645 MONTE VISTA AVE SUITE 305
MONT LAIR, OA 91783
(71 5) 621-6002 (2 DENTISTS)
004277 NIONTCLAIR PLAZA D'I'i, GRP
5182 NORTH PLAZA LANE
MO TDLAI R, CA 91763
(714)625- 3566(1 DENTIST)
004357 FANJILy DENTrISTRY
4921 MORENO ST.
O NTC LAIR, CA 917 63
(714) 625 -3885 (2 DENTIST )
MONTEBELL
000152 GRBG0RYER0BlfNSDDS
1400 WH ITT IER BLVD.
MO NT E8ELLO, CA 9€1640
(2 13) 721 -0799 ( 2 DENTISTS)
000625 DANIEL FARKAS DDS
3301 W. 13EVERLY BLVD.
M0NTEBELLO, CA 90640
(213) 722 }8756 (3 DENTISTS)
004026 RA tE H KoTfIARI. DDS.
2337 1/2 W. WHITT[ER BLVD.
ONTEBELLO, DA 90640
(213) 727 --9898 (1 D ENT1 T)
NTEBELL
004370 Olt. DAVID'S DENTAL
1918 W. BEVERLY BLVD
MONTEBELLO, CA 90640
(213) 724-9536 (2 DENTISTS)
MONTEREY PARK
000527 LAI LAI DRIWAl. OFFICE
118 E. EMERSON AVEN
MONTE REY PAR1� CA 91754
(8 18) 206 --9011 � 3 DENTISTS)
005485 ISAAC CRiEN. DDS
1960 S. ATLANTIC BLVD
4ONTEREYPARK, OA 91754
(213)726- 0770(1 0ENTJ T)
IAGA•
004318 IC L J. PINK. DDS.
350 RHEEM BOULEVARD 9
O RAG A, CA 94556
(51{x) 376 -6244 (3 DENTISTS)
MORENO VALLEY
X000856 'V %gLIAA f RKOIILDD
24463 SUNNYMEAD BLVD.
[OBE NO VALLEY, CA 9238&
(714) 924 --9531 (1 D E NTI T)
110327 FRANCIS E MACDONIALD.DD
12600 liEA OCK. SUITE A-I
MO VALLEY, CA 92553
(714) 247 -2688 (1 DENTIST)
110505 PATRICK S. LEE, DDS
11481 HEACOC T# STREET #160
M 0 R E NO VALLEY, CA 92387
(714) 242-5470 (1 DE NTIST)
110606 FA-lll Y DES *rAL ONCE
CH E RLY JO H NSTON, DMD
24655 8 U NNYM EAD 13LV+]D.
M013 E N 0 VALL EY, A92 53
(714) 242-6242 ( 1 DENTIST)
MOUNTAIN VIEW
000441 MICHAEL JAIME LOPEZ DDS
1704 S IRAMONTE AVENUE
MOUNTAINVIEl+ , CA 94040
(415 )961 - 6809(1 DENTIST)
NAPA
*000228 MAYA DENTAL CROUP
1700 2ND STREET
SUITE 327
NAPA, CA 94556
(707) 252 -3077 (1 DENTIST)
NATIONAL CITY
005464 JAMES A C1.ONT. DDS
SOUTH BAY PLAZA DTL OFFICE
1210 E. PLAZA BLVD SUITE 405
NATIONAL CITY, CA92060
(819) 477 -2787 (1 D E NTJ ST)
NATIONAL CITY
1 10391 KAY OI XO J- RWE RA. DDS
2240 "E" PLAZA, SUITE J
NATIONAL CITE*, DA 91950
(619) 470 -6772 (1 DENTIST)
NEWHALL
*005435 LA RIENCE A' ME DDS
25050 PEASHLAND
-4 202
EWHALL, DA 91321
(80 5) 259- -4200 ( 2 D ENTI T )
NORTH HOLLYWOOD
000484 ALAN R BRODY, DD
12520 MAGNOLIA BLVD
SUITE 202
iORTHHOLL` OOD, CA 1607
(818)762-2662(l D E TIST)
000811 DANIEL HOOD IE D SID
10933 V[ TORY BLVD.
NORTH HOLLYWOOD, OA91 X06
(81 ) So9-3818 (1 0 Ei TIST)
110124 L NAIRE 1, CHANDLER D N ORP
5451 LAUREL CANYON BLVD
SUITE #100
NORTH HOLLYWOOD, C 91607
(6 18) 505 -2250 ( 3 DENTMTS�
NORTH LONG BEACH
004361 DEEP: G. Bo .\'DALE, DDS
$950 PARAMOUNT BLVD.
NO RTH LONG BEACH, CA 90805
(310) 531 -9711 (1 D E TIST)
NORTHRIDGE
000361 LA 'RENcF, G LEVINE DDS
5363 RESEDA BLVD., SUITE 202
NORT RIDGE DEFTER
NORTHFtl0 G E, DA9I324
(818)885-0536(1 DENTIST)
O WALE
000014 RO JERT G L AS BA D DDS
11854 E. FIRESTONE BLVD,
NORWALK, CA 90650
(314) 864 -3011 (3 DENTi T )
005442 AN- rON•IO F AG RA DMD ENC
11595 THE PLAZA
N ORWAL K, OA90 650
(310) 668 -0048 (1 DENTIST)
OAKLAND
000973 FAMILY DENMSn
1510 FRANKLIN ST,
OAKLAND, CA 94612
(5 10) 593 -1923 (3 D ENTISTS)
*004236 FILL HILT. DENTAL G ROUP
400 30TH STREET
SUITE 401
OAKLAND, CA 34609
(510) 444 -0871 (2 DENTISTS)
10/09192 PAGE 7
Piease choose one Of the above participating Sa #e card pr vIders by entering the appropriate provider number on your enrollment card.
Safeguard reserves the right to transfer a member to the nearest provider facility If the Safeguard provider faellity receives an insufficient
an active Safeguard provider. The boar listed doctors With an * are n longer open to now enrollees.
er�rlirrrer�tx or is n longer
SAFEGUARD HEALTH PLAr
DENTAL PROVIDERS CITY OF SANTA TH EMPLoYEES OF
PLEA
E READ THE FOLLOWING INFORMATION SO YOU KNOW FROM WHOM M CSR WHAT GROUP OF PROVIDERS HEALTH CARE MAY 13E OBTAINED.
10/09192 PAG E
of the above participating Safeguard providers by entering the appropriate provider nu ber on your enrollment card.
Please choose 1n P
ateuard reserves
the right to transfer a member to the nealrest provider faculty If the Safeguard provider facility receives an Insufficient
enrollment, or Is no longer an active Safeguard provider. The above listed doctors with an * are no longer open to new enrollees.
GRANGE
PANORAMA CITE
OCEANSIDE
*004308 RAINDY GARLANrD. DDS
004387 ABB AS A. ETEAIADL 10
110300 RON NOURI A '. DDS
DEAN SAIKI, DDS
648 NORTH TU TI f AVE #H
DAN RO EN, DMD
8424 VAN NUYS BLVD.
1310 UN 10N PLAZA CT., SU ITE 200
0 RAN €aE, CA 2687
PANORA MA CITY, CA 91402
0CEANSIDE, CA 92454
(714 ) 771- -0190(2 DENTISTS)
(818) 893 -4222 (2 DENTISTS)
(6 19) 757 --2 13 (2 DENTIST)
*004430 IIAMI l NIKO Ai . DDS
PI�A�1�IC�.11T
r
00417 DA%'ILD A�I001�. DDS.
FABAI�l BEI�i1, pD
200 N. TUTIN AVE, SUITE
O00145 CHIJ1tiC KM DDS
4140 0CEANIDE B LD
f350 #A A E. ALO1+i D RA BLVD.
SMITE ��
DANE. CA 9SB5
#�
(714) 282 -034 ( D EI�TISTS)
P pERADi� NT, 94723
OCEASIDE# CA 9056
(310) 630 -5904 (1 DENTIST)
(619)630-4800(1 DENTIST)
005 402 LANCE LARSON. DDS
�`USTIf� PLAZA DENTAL RDUP
1p00577 ��IA3�E�I S1PAL. DDS
�}(�4 �!!}� fIAD! OAC�A1�l. DDS
1872 NO. TUSTIN AVENUE
8040 . AL0 1� RA BLVD.
3753 I IO AVENUE
SUITE
SUITE F 4
Lr ORANGE, �"k 94665
(7 14) 637 --$662 (7 DETIST)
PARAMOUNT, CA ��123
f]CEAt�iED Er CA 9054
(31 0) 633 -1213 ( 1 DENTIST)
(619) 71--4500 (2 D ENTISTS)
I LPL
�] �]�j { * 1Y'� } # 7 y Y y DDS
0V4Rti78 AR1.r1
AL
����iVV���!'�l��F�� #�i�
004356 [ O 7'� 1� � ENT
�trt# +��IE77�i'ILIILi}qia3111�*
�.+ +lix71#YLItJ�III'LI�J��1
8131 E. F3DSECE�Ai� 1f AE.
JAMES J. DIBEL� AJR DDS
3579 CARD DAM �LI<].
SUITE 101
2420 VISTA WAY
0Rf MLLE, CA 959 66
DENTIST)
(916)533-4770(l
PROUN"C, CA 94723
0CE ANSI D E, CA 92054
(310) 634 -2984 ( 1 DENTIST)
�1y}��-x�+
005495 N -jjP.A COSTA DENTAL GROUP
000471 ALLAN F P OWE LL DDS
00 �* 6` LAN � D
�UU�?4+ #7k£rl+ri ��.�1��5 �� /�J
50 COLLEGE I�i —YE.%
405 � "�17 JTR E ET
�.+��
1730 E. WALNUT
SUITE 13
DXiAI�I:], CA 93434
I�ASDEhIP�,91�06
0CEAN IDE, CA 9205
(805)433'0210(1 DENTIST)
(8i8 )4S -4795(1 DENTIST)
(619)8 �- -T1�2(� DEI�# TIST}
004322 SjjAj,AB11 PUP.]. DDS.
GhiT�1lG
X39 STREET
044 DEI�'�`AL P�.� D131��'�,L R>�
E3}�hlARDy CA 93030
9 SOUTH LAKE A1lEI�fUE
004262 1113si1<ADA 1EiT�'A.DDS
(805) 483 -9537 (1 DE NT I T)
3RD FLOOR
1128 W. M I SSION BLVD
PADENA, CA 91 101
UNITDIGIT D
00 CL �IAI� PE RE DTLCARE
(816)795 - 6855(5 DENTISTS)
i10y CA 1�7 �
-5307
(71if)94`,73ti1 .,}(1 DENTIST)
b�NC�I�T kIABTRET
005257 W1LLIAM YATES DD
OXNARD, CA 93030
903 E. DEL MAR BLVD.
*004290 SHAILA AKHA E, DDS
(805) 983- 6766 (2 DENTISTS)
PASAD E NA, CA 911 1
2217 S. MOUNTAIN AVENUE
��lt�i�i��1
(818) 792 -6195 (1 DENTIST)
ONTARIO, CA 91761
(7 14) 33--5090 € 1 D ENT #STS
00427 G. [jO�'A,�7I,(1FD-lA, DD
*005270 DAVID TANG DDS
13545 VAN NUYS BLVD
137 WEST CALIFOBNIA BLVD,
#0048 LUl I ?A'1AUAy 1]D
UNIT A -4
PASADENA, CA 91145
562 -C WE HOLT BLVD
PACO] A, CA 31331
(8 1$) 577 =2848 ( €� E�#TIT)
{�I�TAR1�l, CA 9752
(81 8) 890- 0703 (1 D EI�TIST)
(714 )388 - 1992(1 DENTIST)
PALM SPRINGS
PERRIS
04 CR0 1t 'A 1IIL. ' p$ 'I'1 �
110370 N11CHAE1, "T`. Af ARTTI , DDS
004359 PEP.RIS MILE E 'M`I R
381 IL ERSON #E
1J
413 DROVE AVENUE
9
225 S. CIVIC DRIVE ;929
PERRI CA 32370
ONTARIO, CA1781
PALM, PR1hIS, CA 92262
,
(7 14) 343 -(3885 (2 D E[�TISTS)
714 94--8698 (2 D Efi�TISTS�
t619) 854-13 ( t €SET #T]
PAL DAL
*1 10229 RICHARD W. ZAPFE, DDS
110610 AR CELT TA O #, D.D.S.
CROSSROADS DENTAL CENTER
527 NO. PALM DRIVE
000853 CO.N1 N1 lJ 'DB TAL C RN-FE RS
1675 N. PERRIS, SUITE A- 1
SUITE O6
2508 EAST PAL DALE BLVD
PERRIS, CA 92670
ONTARIO, CA 91762
PALMDALE, O 93550
�7 �� 940 -439(3 (� DEIVTIT�
( 714 984 --318 ( 1 QE#�T1ST)
{805) 272-9091(3 DENTISTS)
PANORAMA CITY
PI CO RIVE RA
ORANGE
000135 AJ AN -DER O>�DO DDS
000 DA �r MUDITA. DDS
004 NAVIN � A SHAH,
14526 RO COE BLVD.
8619 CHANEY AVE.
710 E. LINCOLN AVENUE
PICO RIVERA, CA 94660
ORAE, CA 7665
PANORAMA CITY, CA 9 1402
(310) 49 -4775 ( DENTISTS)
(714) 321 -2310 (2 D ENT1ST )
(818) 893 -785 8 (1 D E NT1 ST)
10/09192 PAG E
of the above participating Safeguard providers by entering the appropriate provider nu ber on your enrollment card.
Please choose 1n P
ateuard reserves
the right to transfer a member to the nealrest provider faculty If the Safeguard provider facility receives an Insufficient
enrollment, or Is no longer an active Safeguard provider. The above listed doctors with an * are no longer open to new enrollees.
SAFEGUARD HEALTH PLAN"
DENTAL PROVIDERS FOR THE EMPL.)YEES OF
CITY OF SANTA ANA
f LFA E READ THE FOLLOWING INFORMATION SO YOU KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.
PI CO RIVERA
RANCHO SAN DIEGO
RIVERSIDE
004373 AS110K N'1 irr DDS. INC
004410 COTTONMGOD DE -rAL GROUP
000066 RONALD $ LOW DDS
r ,
9614 ail H$TTIER BLVD.
2451 JA A HA ROAD
6850 BROCKTON AVE, SUITE 104
PICO RIVERA, CA 90660
RANCHO SAN DIED , CA 92019
RIV ER EDE, CA 92506
(714) 683 -5490 (1 DENTIST)
(310) 942 -2345 (3 D ENTISTS)
(61-9)444-0500 (1 DENTIST)
PLACENTIA
REDDING
000473 CO3N1N1UN)TYDE3\TALCENTMq
994476 C III rKA M. RAJU. D' iD
000388 WILLIAM L FARRELL DDS
6005 ARLIN GTON AVENUE
155 EAST CHAPMAN AVENUE
REDOING DENTAL MALL
RIVERSIDE, CA 92504
�714j 359- -8675 (2 DENTI TS)
PL OE T #A, CA 97570
2701 EUREKA WAY
(714) 579 -7785 (1 DENTIST}
REDDING, OA 96001
(916)24Z-9426(i DENTIST)
�}��198 oNj'iLIT'I)EN-rA],E*Y`SRS
REDONDO BEACH
SUITES I &J
090848 STEVEN M HAVES DDS
1952 CONTRA COSTA BLVD.
*000219 ALPHO SO A VALDES DDS
RIVERSIDE, CA 92507
PLEA A T RILL, OA 94523
i50i SOUTH CATALINA
(714) 6 - -02#0( 2 DENT1 TS)
(510) 825-9 6 63 (Z DENTISTS)
REDO DO BEACH. CA 9 277
(3101540-6611 ( DENTISTS)
004303 ELl07,13.VE0DDS
3410 LA SIERRA AVENUE
POM1V
000371 0M%'I1]'1"T`1* DENI'AI. IE3'I'$RS
0053 $AY KAHF'IA. DA'iD
RIVE R51DE, 95
(714)354-9550(l DENTIST)
1640 N. INDIAN HILL BLVD.
923 ATAL1NAllENEIE
POMONA, OA 91767
SUITE B
RE DON D0 REACH, CA 90277
004312 J011N J. CESAFJO, DDS
(714) 623 -6708 (4 D ENT# T)
(31 0) 540- 85 15 (3 DEi TI STS)
6860 8 H CKTON AVENUE
SUITE 1
0042 ITARI~iET' SINGH SILL. DDS
*005394 �ILLARD II NiMU D}S
RIVE RSIDE, A 925E6
72 EAST ARROW i�'
1711 VGA EL PRADI�
(714 684 -917 (1 DE1�3I5T)
PD�V{C�At t 5167
(714) 621 -9177 (2 DENTIST )
SUITE 201
s�EDOI�fl�C3 BEAM;, 90�"7
00441 DONALD I. PEARDJ�
(310)540-4345(l DEITIST)
8pp877 [#0 ROK�DN EB E
*U(�8468 I�'I'3.. ASSOC OF P��10�'
ppB
fyFV�fl1 Dl*i LA 92518
180 E MISSION BLVD
REI�OOC I'
(714) 682 -225 (1 DEiT #ST)
�C�P+I�k, OA 91766
�7 i4) 623- 5278 ( D E#T €STS)
0134+18 �IsR�'ARD D. ALFS. DDS
R SEMEAD
1375 BROADWAY
REDWOOD CITY, A 94063
009614 LE ROSE jDENrAL E1�TRR
1
11 TO *7 ' DAI I I � DDS
(415)364-4566(1 DEt�T� T}
BORIS Al DDS
POMONADENTAL PEOIALI T
8951 GLENDON WA's
175 W. LAVER NE AVENUE, SMITE A
�'�� DALE I�II�'IiII�. III
ROSEMEAD, A 91770
PCiV�I4O 91787
16941,OO DS] D E READ 17
DEISTS)
(8 18) 8$ -7'667 ( �`
(T i4) 583 --555 (5 OEP,IT�STS)
REDWOOD CITY, CA 9408
ROE11lL��
POI�V
(415)3-8982(i DENTIST)
*004488 ROSEVILLF, DTL ASSOC
095258 F RAJ ADBH AM) -BAV, E RDDS
���
EDWARD L. RUCHL.EY, DDS
1588 35 5 PL3k`VIERADO ROAD
1000067
HARVEY E DLU ATCH DDS
01 SUNRISE, SUITE A -1
SUITE # 1 i
18909 SIB ERi A i WAY
KOSEVILLE, CA 95661
F�(I ti A 92064
#I =SEDA, CA 91335
(546)784 -i01 ( DEBT #STS)
(818)487 -�11�3 DEt��`�TS)
(818) 345-13 ( 1 DENTIST)
1;i1l_ND 1-1E1iHT
RANCHO O O I CONGA
06436th JOSEPH IIA KIMI, DDS
� X44 9 U� II. I.►I l�. Ids
*000394 DODUL.AS W- JORNSO , DD
6660 RESEDA BLVD.
L
1856 EASE` £�L.I#�iA READ
628 I�BIEI..IA
SUITE #1018
RpWLAD HEIGHTS, OA9�74RANCHO
RANCHO BOAIC�A$ CA 917�}1
(618) 965-0971 (3 DEI TIST )
(714) 987- 4113 (2 DENTISTS)
RE ED , CA 9i335
(818)70 -944( 1 DENTIST)
065372 VVILLIAM 0. RE MA N. DDS
*065482 NJ C JJAI3l.11I C YdNS -fER. DDS
RIALTO
1818 SIERRA A LEONE
9683 BASELINE ROAD
RAN HD O,4I�+ O A, OA 91730
*004452 FAMILY DENTISTRY
RtO. BOX $247
ROILA[�D I�E��TS, CA 91748
(7i4)989 -17580 DEI�#TISTS)
531 f�E�TN RIVERSIDE
}984 -237 (1 DEFT #"I)
RIALTO, A978T8
RANCHO PENASQUITOS
(714) 820 -2274 (1 0 ENTI T)
110368 STEVEN." 1, CHIU, DDS
004468 SrEPHEN J. RUBINKA
Rllll�'fOID
#!SOB E. AL1'! AVEI�ii�E, LATE B
9728 R1�14EL ITT. ROAD
0028 TERRA' 1, TAN ER DDS
ROWLAND H EIGHTS, A 91746
SITE
265 i6Tkt STR�ESTREET
(9i3)65 -618�2 0 E1TlST)
#�E3 IT� 9229
RAfi+l PEIA {�
(S19 ) 484 --258 (1 DENT1 T}
R1OI�{OA,�D, C94 801
(5 10) 233-6515 (1 EIE#TIST)
10/09192 PAGE
Please
choose one of the above partIcIpaling Safeguard providers by entering the appropriate provider number on your enrollment card.
afeuar
d reserves the rl ght to transfer a member to tha nearest pr vIder faellity It the Safeguard provider f elllty receives an Insuffl lent
enrollment, ent or is no longer an active Safeguard provider, The above listed doctors with an * are no longer open to new enrollees.
SAFEGUARD HEALTH PLAW" ERS DENTAL . RCIANTTYDOF S A ANEMPL,,fEES OF
PLEASE READ THE FOLLOWING INFORMATION YOU KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.
SACRAMENTO
SAN DIEGO
SAN FERNAND
*004338 JOHN R. F ROR, DDS.
7100329 V I 4% CRAW F'OR DDS
00527 3ERRY 17 MA1XIEUS DD
FERNANDO DENTAL ENTER
1722 PROFESSIONAL DRIVE
5106 FEDERAL BLVD., SMITE #209
V�fj�N
12 5 SO. BRAND B LVD.
SACRAMENTO, O, A 95825
SAN DIEGO, �. A 05
SAN FE RNANDO, CA 91340
(916) 486 -8282 (2 DENTISTS)
(61 9) 264 -0179 (2 DEI TISTS)
(818)365-6321(3 DENTISTS)
*005283 ]ERIC 1? PHILLIPS DN-11D
*000517 ROBERT ENGC1flNDDS
�► FHA�#1
930 FLORIN ROAD
5450 LAIBE#DNT MESA �3L1�D.
011 gIIA2��1'I«D�1D
SUITE 101
SUITE
SAN 0 1E0, A9117
SANTA �3Df#Al1E., Sk�kTE 10�
A0RAM E#�ITD, A�9583i
(61$) 292755 1 �1EhfT[ST)
SAN FRANCISCO, CA 94112
(9 16) 355"i949 ( 1 DEI�TfST)
(415 )568-59(1 DENTIST)
110548 BREW, J. VA RS H AWS KY. DDS
000553 RANDALL WrOLO I O DMD
LAIREhIONT FAMILY DENTAL OFF
�O�O� I1A i .E � 'IPADS
1941 WATT AVENUE, SUITE
L I - MV i T R#Y SUITE 14
670
L / T VAN NESS y E, y E 202
SAC Y E TY t Y F 9 5 Y L
(916)48-5 677 ( i pE#�TIST)
V t
A DIEGO, CA 92117
�# FRANCISCO, CA $41{3S
{ 19) 273 -0540 (1 0 E NTI T}
((4 16) 441-2098 D E VTI TS)
DIi1 I � S 8 DDS
*000054 TIERRA AIhTA DeNrAL LAP
000437 i R1,ES A A DRILL DD
..
505 E. R�]I�+IIE LANE
505 E.
RONALD G. PET`RIL�.O, DD
494 MISSION TREIa�'
10715 TIE R RA AI TA 8LVD.
SAN FRANCISCO, DA 94111
�#
J
AI' DIEGO, CA 124
(415)921- 1209(4 DENTISTS)
Si3l�TE
DA939 (3�
(408) 443 --4573 ( i DENTIST)
(619) 560 -5222 (2 DENTISTS)
00008 CHARLES NIP 005
SAKI BERNARDINO
000729 NINI ' i EN —rAL CENTERS
240 SHOTWELL STIR E ET
000020 WA LTER ANT) E RS DDS
5382 BLAIREMONT MESA BLVD.
SUITE 230
SAN F 8 AN CIS GO, CA 94110
1879 IN. WESTE WEST RN AVE .
SAN DIEGO, DA 92117
(415) 431 --9797 (2 DENTISTS)
SAN 8 E RNARDINO, CA 92411
(619) 560 -9177 (2 DENTISTS}
(714 ) 67 - 1212 (1 DEIVTIT)
(}00747 HERNARD J nNTLAY DD
*004329 N.N-T KOLAR Fr- E NSS ON DD
0002-38 JAM FS S C110 DIES
6571 IMPERIAL AVE.
380 20TH AVENUE
2130 N. ARROWHEAD, AVENUE
SAN DIEGO, CA 92114
SUITE 301
SAN FRANCISCO, 8A 94121
SUITE 201
(6 IS) 262 --0781 (2 DE NTISTS)
(415)752- -0844(1 DENTIST)
AN BER ARDINO, CA 9 405
(7 14) 882 -7211 ( 1 DEINTIST)
004300 .NjpRSII)3N'9j1<'E 1H- BALT11 CTR
D4 1III�OLITO M. Br�iiR lA. Hl�
000308 PONCE CKUNSTER
3177 OCEAN VIEW BLVD
SAID` DIEGO, CA 92113
2460 MISSION STREET
a
1897 WATER MAN
(6 19) 231 - -9300 (2 DENTISTS)
SUITE 211
AN F RAN CISDD, CA 54110
SAVE BERNARD €NO, CA 92404
004309 'IEPREN ARAL. HH8
(415 $ 1 --7647 { i D E#�TIST)
(714) 686 -4694 (4 D ENTI T)
3651 FOURTH AVENUE
000490 111A fi r 1-UU I DS
SUITE 310
004444 BERNARD (;OnALES, DDS
1550 NORTH D. STREET
SAT DIEGO, DA 92103
2720 24TH STREET
SAN F RAN CISCO, CA 94110
SAN BE RNARD[NO, CA 92405
(619) 2SF --2942 (1 DENTIST)
(415)282-4566(1 DENTIST)
(714) 884— 2109 (1 D F#+ITIT}
0
*004372 KEG -DALL ] AIMILY DE VISTRY
1442 UNIV E RSIT r AV E N U E
004465 M IC1 IAB 1, J. P1NK. DDS
500 SLITTER STREET
985 KENDALL DRIVE
SAN DIE O, DA 92108
SUITE 234
SAN 8ERNARDIN0, CA 9 407
(619)257- 6104(3 0EINTIST)
SAN FRANCISCO, CA 94102
(714) 881-4045 (2 DENTISTS)
005315 WILLI&M CARL DD
(415) 781 --6128 (1 DENTIST)
004482 DAVID NvE r RBER , DDS
3333 STH AVENUE
���'� RDDDLFDis2tA.I�DS
1357 �:Et�D�.L DRIVE
SAN DIEGO, A3210
4472 IISSIDN ST#E 14T
SUITE 10
(519 99-255b (3 DENTISTS)
SAN FRANCISCO, CA 9431
SAN 8 E I`3NAR D I ND, DA 92407
(415) 587 -0594 { DENTISTS)
(741 �� —�9 � � EI�TIT'S�
ODO I�OR'8i`.E3�'D i��'rAL OFFICE
D8. HI€'PESTEEL E. DR. BEHEST
SAS! DIEGO
845 HORN BLEND SUITE A
*110156 NIA UEL, 1.. -HERSO. DDS
000277 RICHARD D KATIVIK DDS
SAN DIE GO, CA 92109
4472 MISSION STREET
SAN FRANCISCO, CA 9411
INDEPENDENCE SQUARE
(6 19) 270 -6754 (2 D IF NTISTS)
(415) 587 -0994 (2 DENTISTS)
7315 CLAIRMONT MESA BLVD.
SAN DIEGO, CA 92111
110224 SPEC." rRUNt DEN II<L,►TH C TR
1 � X13 �t$I�'� I?III'l�R. �]D
(6 19) 569 --566 (4 DEITETS)
LYNNE ISh�15t DDS
3106 FILL MORE STREET
11230 SORRENTO VALLEY ROAD
SAN DIE O, DA 92121
SAN FRANCISCO, CA 94123
(6 19) 4589126 (4 DE MIST )
(415) 922--5322 (1 DENTIST)
10109/92 PAGE 10
Please choose one of the above participating Safeguard providers by entering the appropriate provider number on your enrollment card.
Safeguard reserves the right to transfer a member to the nearest provider faclilty If the Safeguard provider facility receives an Insufficient
enrollment, or is no longer an active Safeguard provider. The above listen doctors Frith an * are no longer open to new enrollees.
• SAFEGUARD HEALTH PLAT
DENTAL PROVIDERS FOR THE EMPLOYEES OF
CITY OF SANTA ANA
PLEASE READ THE FOLLOWING INFORMATION U KNOW FROM IWHO OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.
SAS! FRANCISCO
SAN PED R
SANTA F A
t 10304 DAVID A. O CEP I �. DD
004400 RA ION PORTALES. DDS
000702 iYNjUl%% DEN-r AL CENTERS-
128a - 22ND AVENUE
946 NORTH WESTERN AVENUE
1820 BELLOMYSTREET
SAN FRANC] S O, CA 94122
SAN PE0RO, DA 90732
SANTA CLARA, DA 95058
(415) 664 -1234 (2 DENTISTS)
(31'0)831-0735(l DENTIST)
(408) 241 --0242 (2 DENTISTS)
SAN GABRIEL
110522 m. wA,yNig mARTiN. DDS
SANTA FE SPRINGS
000 104 RONA LL 1%1 LS ON DID 9 1 NC
520 W. 7TH STREET
000392 K S PRASAD DDS
206 E. LAS -T U NAS 0R.
SAS} PEDR , CA 90731
11504TFLF0 RAPH ROAD
SUITE 7
(310)832 -5361 (2 DENTISTS)
SANTA F SPRlN0S, GA 94670
(310)866- - 3254(1 DENTI T)
SAN GABRIEL, CA191776
} 285-1159 (1 DENTIST)
SANTA ANA
SANTA MARIA
000390 l(� is GOHRN Im
000576 GEOFFREY DU I -.DDS
1913 E. 17TH STREET
000733 ROBI3RT W. EVAN S. DDS
1323 SOUTH SAN GABRIEL BLVD.
SUITE 113
326 W. MAIN, SUITE 120
SUITE #R
SANTA ANA, CA 92701
SANTA MARIA, G 93454
SAID GABRIEL, CA91776
(7141547 -9751 (l DENTIST)
(805)928 -5671 (1 DENTIST)
(i8)88 -6181 ( i DENTIST)
SANTA MONICA
000708
00 954 DELMAR FAMILY DTLCTR
8 121 .17TH STREET
000571 VALEDF.NTAL C E DER
702 SO. DEL MAR AVE.
SANTA ANA, CA 92706
EUGENE G. FIELDS, DDS
SAN G AS RlEL, CA 91776
(714)542-5440(1 DENTIST)
2826 SANTA MONICA BLVD.
SANTA MONI A, CA 90404
(818) 287 -9781 (2 D E TISTS)
004310 VAUGHN O. SI'EWART. DDS
(310) 453--5436 (2 DENTISTS)
SAN JOSE
1136 W. EDINf R
0 0 05 STORE' DE'1'A�.11EA1..T�1 GTI:
SANTA ANA, DA 92707
���� AI,�II� IkUI33�'�'El N* DDS.
2454 STORY ROAD
(714) 540 -2836 ( DENTISTS)
8 SANTA IjJ«i�II A BL1lLl.
SUITE
SAN DSO, DA 95122
(4f33) 72-f�888 ( 4 D EST €STS}
00434 BIi1S'1'(11. I�`A�'#IL�' DFTI�'l�l'
SANTA MONICA, D�1904�1
27{7 N. BRISTOL
(310)393-6284(1 DENTIST)
004399 NlXNljjAR. DD
yVy
SUITE #F- 1
ANA, CA 92 706
*005303 L A r1 1 N V y G y . NEf D
D
FV VV STORY
Fil
(714) 569-0021 ( DENTISTS)
SANTA �+IDI�lI D ETL
SAN JOSE, CA 95 127
1244 7TH STREET, SUITE 10
(4D8)256-8664(2 DENTISTS)
10221 NORA CABALLERO, DDS
.
SANTA MONICA, CA 90401
004409 TRI - CM' DENFAL
406 S. MAIN ST RE ET
(310)393-0743(l DENTIST)
20 POST STREET
SANTA ANA, DA 92701
SANTA ROSA
SAS JOSE, CA 95113
(714) 3721498 (1 DEhITIST}
0084 NIMiJNFI'Y DE"I'AL I:'rEEI9
(40819 93- 9222 ( 3 1) ENTISTS)
1027.5 BRISTOL FAIMILY D'TL GTR
2525 CLEVELAND
SAKI JUAN APISTRA I
1425 S. BRISTOL STREET
SUITE S
*005354 S AX lUA ' MENTAL ASS 0 lAT
SANTA ANA, CA 92704
SANTA ROSA, DA 95401
(707) 578-3118 t 1 DENTIST}
31878 D EL OBISPO
(715) 540 -7101 ( 1 D ENTIST)
SUITE 9
SAN" JUAN OAPIST RAN 0, A 92676
110287 11R1 Pl ' lIANG, DDS
� � � IRA � I�I�', DDS
(7 #4)661-290{ 1 DEr�#TIST)
237 W. EDINE#�A1�E., SUITE
PR�IETOI pEi�TAL
RI
SANTA ANA, OS270d
391 PRINCETON DRIVE
SAKI MATEO
(714)868-1688(l DENTIST)
SANTA ROSA, CA 95405
(707)542-7740(1 DENTIST)
'000802 GIIARLES M. LEX'IN, DDS
X0€1 N. SAN ATFO �]RIVE
SANTA BARBARA
SAI�IJ
SAN i4�iATED, G+�844�1
00472 TA�'E'1tEEx1`1�T'�.RP
05 pI,DE�'�,�'GLI }Dlsl�'�`l.
���5�543- 0895 {1 p�i�#T1ST�
191 STATE STRFET
GEORGE W, EI INS, DDS
ASV PEDRO
SUITE #308
SANTA BARBARA, CA 93101
21700 W. GOLD E I TR[AN G LE RD., ST
*0 MICHAEL S H ULTZ DDS
{805) 682 - -5762 (1 DEINTrST)
SA US, CA 91350
(805) 259- 5562(1 DENTIST)
400 S. GAFFEY STREET
SAN PE BIRD, CA 98731
005263 DAVID LEE THORNTON DDS
SII�I VALLEY
(310)548 - 1665(1 DENTIST)
76 HOLLISTER AVE #110 -A
004302 DON R. SIHRE.SIDS
*000696 PINAKIN O PARIKII DDS
SANTA BARBARA, CA 93111
(805) 967 -0710 ( 1 DENTIST)
1975 ROYAL AVENUE
Sl f VALLEY, OA 93065
/�yy ��{{
204 /y IP f+ E.
*005398 BELLORR VI'1IU RAI. DD
(805) 522 -3838 (1 DENTIST)
PED GA
(310) 832 --0291 (1 0ENTI T)
PACIFIC DENTAL
3324 STATE STREET SU ITE L
005301 SRI IVA N1011AN DDS
SANTA 13A R SARA, OA 93105
2345 ERHINGER ROAD
(805) 682 -8125 (1 DENTIST)
SUITE 220
IMI VALLEY, GA 93065
(805) 622 -0191 (1 DENTIST)
10/09/92
PAGE i i
Please Choose one of the above participating Safeguard providers by entering the appropriate
provider number on your enrollment card.
the right to transfer a m ember to the nearest provider facility If the Safeguard provi faculty receives an Insuffielent
Safeguard reserves
enroll ment# or Is no longer an aolive Safeguard provider. The above listed doctors with
an are no Ionger open to now enrollees.
;.. SAFEGUARD HEALTH PLAr'
DENTAL : ROVIDERS FOR THE EMPL%jYEES OF
CITY OF SANTA ANA
PLEASE READ THE FOLLOWING I INFORMATION YOU KNOW FROM WHOM R WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.
IMI VALLEY
SUNNYVALE
TORRANCE
005352 RALPH JMAIELLO JR DDS
004301 N E BNA K. CI1AN -DIOK. DDS
00536$ JOSHUA C.H. CIVIL€ DDS. 1
495 E. LEIS ANGEL ES AVENUE
990 W. F R E M 0 N T 11ENUE
DEL AMO MEDICAL CENTER
S I M I VALLEY, CA 93065
SMITE C
21320 HAW rHORI E BLVD SUITE 212
(805) 584 --2228 (2 DENTI T )
S NYVA1_ E, CA 94067
TORRANCE, CA 90503
{403) 720 -8555 ( 1 D ENTIST)
(3101543 -1003 (1 DENTIST)
SIJTI -1 ATE
sour" TE nENTA>L, ROtrP
000109 �i
TARAJA
110158 A.L. �RA.SIi, nns
44 TINE E D�' BL1iD.
000 THEODORE D TO:� #I3L DID
TDRF�ANCE DEI�}TAL SCGfATES
SOUTH GATE, CA 90280
18525 VE TUR 8L-VD.
X7825 C1 E 4S1- AV BLVD +, SE11TE 2f E�
(213) 567 - #227 (4 DENTISTS)
TAR ANA, CA 91355
TOR RAN CE. CA 90501
(8 18) 708 -7101 (2 DENTISTS)
(310) 327 -4186 (4 D ENITIST )
004294 Y. c,. SIIAIEii DDS
TEII�E1Jl�
T�1lLDi
��SATl�h1A
SOUTH GATE, C 90280
OD4 T1 TEMEC D>�NrAL GROUP
00 WILLIAM . TYM. DDS
(310)583 -1481 ( 1 DENTIST)
415931 N1NCHESTER ROAD
622 EAST OLIVE
SUITE 211
TU RLO CK, CA 95380
004393 KYONG M. LEE, DDS
TE M ECULA, CA 92590
(2 09) 686 --1 80 � 1 D ENTIST)
5841-C FIRESTONE BLVD
(714)599 -3449( # DENTISTS
TIJTI
SOUTH BATE, 9280
(310)806-4776(l DENTIST)
THOUSAND }�
04390 ,�o�ATIjA,stx. PANG. DDS
0043 67 VAR UJ'I't AZI IAN
17482 IRVINE BLVD
SOUTH PASADENA
333 S. MOORPARK ROAD
SUITE E
000254 PETER A PAPPAS DDS
T HO U SAN D OAKS, CA 91381
TUSTIN, CA 92680
2050 HUNTINGTON DR.
(8{ 5)497 -9491 (2 DENTISTS)
J714)731-6677(i DENTIST)
SUITE A
SOUTH PASADENA, C 91030
*005305 MAN ALA. P TIL HOLT DDS
UPLAND
(8#8)441 - -2975( # 0E# TIST)
148£ AVE IDADE LOS AR OLES
*000230 UPLA1 SAID AN'T'ONIO DTI,
THDUSAND OAKS, CA 91360
811 E. 11TH STREET
004280 SUSAN LEi 'O. X}D
(305) 432 -8050 (1 0ENTIST)
SUITE #208
1605 HOPE STREET
UPLAND, CAB 1786
SUITE 333
110561 VAL NA MASTER. WIL .
(7 14) 946 -8590 I DENTIST)
SOUTH PASADENA, CA 91030
1342 E. THOUSAND OAKS BLVD.
(818)799-1288(1 DENTIST)
THOUSA 1D OAKS, CA 91362
000 DO ICI AS W. JOII 'SOI't DDS
(805)497-7505(1 DENTIST)
1277 W. FOOTHILL BLVD.
SPRING VALLEY
UPLAND, CA 91786
* 10 370 j jN S. SONG. ODs
TIJUAN , MEXICO
(714)991-3341 ( 2 D E NT1 STS)
9628 CAMPO ROAD, SUITE W
110406 CLINICAL DTL DE TI DANA
S€'R1txlO1�ALLE�',CA91977
Ai�CELI�RRANO�f.iDDS
*��i�iJ�9 ��AR'I`I� *I✓KA►�'4DDS
( #9) 461 -7285 (1 DENTIS
1815 5TH AVENUE, ECON D FLOOR
i30 S+ 1�1iC�lJi TAI f AVENUE
TIJUANA, MEXICO, CA 92173
SUITE #C
T D T
(0 11) 851-610 0 (3 DENTISTS)
UPLAND, CA 91786
(714) 949 -7402 (1 DENTIST)
005264 RONALD JOB* DDS
1240 W ROBINI OOD
T RRAN E
SUITE D
*000131 ISAAC ITUANG DDS
*005309 UPLAND DMNTAL OFFICE
STOCI TCI , CA 95207
3600 LO ITA BLVD.
350 SOUTH EUCLID AVENUE
(209) 472-7088 (1 €AEI TIST�
SUITE 201
SUITE
TOR RAN CE, CA 90588
UPLAND, CA 91786
STUDIO CITY
(310)326-3858(1 DENTIST)
(714)946-8334 (1 DENTIST)
110354 SUIII IYENAR. DD
VALLEJ
LAUREL ANYO B1`D.
X00561 MMv1)I3TAI.,i NrEP
SUITE f
1730 SEPULVEDA BLVD.
004752 VALLEJOIDEN -rA #C RE
STUL3IC� CITY, CA 91604
SUITE
RICHARD A�. SP4 St DDS
RICHARD
(818)7 2 -0307 (4 € ENT1ST)
TOR RA lCE, CA 90501
15 2 NAPA STREET
(310) 325 -5244 (2 DENTISTS)
VALLEJO. CA 94590
SUN VALLEY
(707) 648 -0194 (1 0 ENT] ST)
000299 SUN VALLEY DENTAL GROUP
000864 VILLAGE FAIMILY DENTAL
1fAl �II�
i�E1�1NE A�i€� i1EINS�'EIN
1235 W. SEPULIIED BLVD.
� � 1* 1 = RrA�o ROAD
��� 9U�
{300012 ROBERT �r1 }�
SUN VALLEY, CA 9 #2
(310) 0-956 ( DE[�TfTS)
630 VAS hfEl'�S BLVD.
#)76-- 3410 (4 DENTISTS)
VAN k.IY, CA914�
*OD4 51 181 ST FAmiLy DE -ri TRY
(818) 787 -6400 (4 DENTISTS)
LAWR E NC H ASH IM TO D.D.S.
20144 HAWTH E3 RN E SLV D.
004383 MID VALLEY DENTAL AL CARE
TOR RAN CE, CA 90503
15720 VE NTURA BLVD
(310)371-8888(1 DENTIST)
SUITE 300
VAN NUYS, CA 31436
(al 8) 9 9 D-6669 (I DENTIST)
10109/92
RAGE 1
Please choose one of the above participating
Safeguard providers by enterling the appropriate provider number on your enrollment card.
Safeguard reserves the right to transfer a member
to the nearest provider #a lity if the Safeguard provider facility re elves an Insufifi lent
enrollment, or Is no longer an active Safeguard
provider. The above listed doctors with an * are no longer open to new enrollees,
>AFEGUARD HEALTH PLAI
DENTAL PROVIDERS FOR THE EMPLUYEES OF
CITY OF SANTA ANA
PLEASE DEAD THE FOLLOWING INFORMATION SO YOU KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED.
VAN t UYS
0 04384 DAVE KRILL. ITS
16922 8 H E R MAN WAY
VAN NUYS, CA 91406
(818) 344 -6202 ( 1 DENTIST)
VENTURA
*000555 JOEL A. GOLDENBERG DDS
5700 RALSTON - SEMITE 343
VENTVRA, CA 93003
(885) 642 -4541 (1 DENTIST)
005271 RONALD ,I• LEE DDS
3442 LOMA VISTA ROAD
VENTURA, CA 93088
(805) 658 -0232 (3 DENTISTS)
005414 DRVL G 016'ADIA DDS
2533 EAST MAIN STREET
VENTURA, CA 93003
{805)643-0700(1 DENTIST)
V I CTO V I LLE
004324 HARRY J. 6F I NE R. DDS.
15366 11TH STREET
ECTORVILLE, CA 92392
(6 19) 245 --8616 (3 DENTISTS)
004463 S. M. BRAT T. DDS
VICTORIIILLE FAMILY DENTISTRY
14495 SEVE NT H STR E E T
VI TORVILLE, CA 92392
(6 19) 245-780 0 ( 2 D E I TISTS)
VIALIA
000467 J NIE T PHILLIPS DD
5423 W. HILLS DAL E DRIVE
VISALIA, CA 93291
(209)625-2488(l DENTIST)
VISTA
000172 DAVID B JENKIN LIDS
161 THUNDER DRIVE, SUITE 20
VISTA= CA 92083
(619) 758 -8506 (1 DENTIST)
000725 COMM Uj%% 'DE -m CEINTEU
1010 E. VISTA WAY
SUITE A & 8
VISTA, CA 92083
(619) 940 --8811 (2 D ENTI TS)
110121 DONALD FELLA .DDS
PARKPLAZA
973VALETERRACE DRIVE
VISTA, CA 92084
(619)940-4286(l DENTIST)
WEST C VIN
000039 GREGORYROBINS DDS
FAMILY DENTAL CENTER
1129 SOUTH GLENDORA►AVENUE
WEST COVE NA, DA 91790
(8 18) 919 -7707 (3 D ENTISTS)
WEST COV114A
000379 30HNTTH0,N4PS01NDDS
126 S. GLENDORA AVENUE
WEST COVI NA, CA 91790
{81 8) 918 -8513 (4 DENTISTS)
004290 JOSEPH LILT. SIDS
1014 S. GLEN DORAAVENUE
WEST COVINA, CA 91790
(818) 318 --2886 (1 0Ei TIST)
WESTLAKE VILLAGE
11 0560 S.M. BANK]. D.D.S.
141 DUSENBEBS DRIVE
SUITE #3
WE TLAKE VI LLAG E, CA 91362
(805) 497 -0989 (1 DENTIST)
WESTMINSTER
STER
000111 CHRISTOPIRE - Way +Grans
9900 CFADDEN, SUITE 102
WESTMINSTER, CA 92683
1714) 531 --1131 (# 0ENTIST)
004282 STEVEN BUI. DDS
1 .5751 B RODKH RST
SUITE #109
WESIMI N STER, CA 9266S
(714)775- 44i6(i DENTIST)
004411 HONY.CAO.DDS
7689 WESTMI NST E R AVE N UE
ESTMIN TER, CA 92 83
(714) 883 -1856 (2 DENTISTS)
1HITTIE
005399 MOSHR ABRA OVIC1. DDS
14564 E. WH ITT[ ER BLVD.
WH IT-TI ER, CA 90605
(310) 693 -8292 (2 DENTISTS)
WOODLAND FILLS
000052 8 H I3LDON NARIN DDS
5348 TOPANGA CANYON
SUITE 210
WOODLAND HILLS, CA 91364
(818)348-3880( 1 DENTIST)
000337 EDWARD L ROSEN ROSE DDS
6001 TOPAN GA CANYON BLVD.
SUITE 320
WOODLAND HILLS, CA 551367
(818) 999 -6165 ( DENTISTS)
YUAIPA
*005498 COREY N'I H LL. DMZ)
IMPERIAL DENTAL CENTER
12137 STH ST
YU CAI PA, CA 92399
(714) 797 -1136 (2 DENTISTS)
YUCCA VALLEY
1 10583 M. AYNE h4AKr1N. DDS
54663 TWENTY NINE PALMS HWY.
Y CCA VALLEY, DA 92284
(619) 355 -2351 (1 DENTIST)
10109192 PAGE 1
Please choose one of the above participating Safeguard providers by entering the appropriate provider number on your enrollment card.
Safeguard reserves the right to transfer a member to the Nearest pr'ov1der facility If the Safeguard provider f Illty receives an Insufficient
enrollment, or is n longer an active Safeguard provider. The above listed doctors wIth are * are no longer open to new enrollees.
Washington
BELLEVUE
001 024
N c cwANG Im . PS
14505 B EL -RED ROAD
BUILDING #A
BELLEVU E. WA 98007
(206) 644 -$445 (I D E NTIST)
001173
KEN BL NETT. DDS
12737 BEL -RED ROAD
BELL EVUE, WA 98006
(206.)451-9001 (1 DENTIST)
KENT
001156
I)EN'NIS IDYSON DDS
10920 S. E. 208TH STREET
KENO`, WA 98031
(206) 854 #4570 (1 DENTIST)
MERCER ISLAND
001151
BAI Nf NO"TARAST DD
2558 89TH AV EN U E S. E.
MERCER I LAND, WA 98040
(206) 236-2-68111 BENT] T)
OLYMPIA
001175
BRUCE AL. CRASWELL. DDS
3773 MARTIN WAY N.E.
OLYMPIA, WA 98501
(206)438 --0711 (1 DENTIST)
SEATTLE
001042
RICK CHAVEZ. DDS
8006 I TN AVENUE N.W.
SEATTLE, WA 98117
(206) 789 -6377 ( 1 DENTIST)
VANCOUVER
001023
CARL R WAGNER WMD
1815 "D"STREET
VANCOUVER, WA 98668
(206) 694 -1041 (# DENTIST)
f
10109192 PAGE 1
Please choose one of the above participating Safeguard providers by entering the appropriate provider number on your enrollment card.
Safeguard reserves the right to transfer a member to the Nearest pr'ov1der facility If the Safeguard provider f Illty receives an Insufficient
enrollment, or is n longer an active Safeguard provider. The above listed doctors wIth are * are no longer open to new enrollees.
N
REOUEST FOES
COUNCIL ACTION
t
5
y 5
T
..r ..r e ber 9, _10-912
� 1N ; E
�. EMPLOYEE GROUP ILNS N
RENEWALS
f
�.4,.,.r v
WEC 0 M M =� �I
i
F CLERK o �o �'
� roved
I '
As Recommended
See Minutes
0 rd i nanCe on st Reading a
0 rd i nance on 2nd Re a it
Imolementing Resolution
Set Public Hearing For j
Continued o:
FIB S:
Direct... y the City ttor e and authorize ayor and
Clerk of the council o execute agreements wit enticare and
ogee �rsraoe reewals commencing October 1, 19#92.
DISCUSSION
e t ' s employee to ee group insurance policies, contracts and
agreements renew a ua-2 1 o October 1 an d are listed be ow
baser uda ion eaa
- I AA A la o.L California: Health Maintenance
Or a o NA S to f and Private Practice 'Plans
- c I gor of Southern c � i-a (Hr%a-alltth ea t Ma � .
Net)
Pacific Coast Administrators: Claims Administration for
Self- Funded Dental Plan
-� -�
Safeguard ealt-h Plan: Pre-Paid Dental Benefits
,-a and Insurance Company: Lif e and Accidental Death
i s to ber e t Insurance; Long-Term is ilit y Insurance
All rates discussed in C-is memorandum are monthly and based on a
coati n a -io of the e xi "C_ ing bene 'Its, except for Saf eg and I
benefits. ts. ecti e October , 1992, Safeguard will be offering a
new plan design to Ci ' Y of Santa Ana employees. This new design
alongside � r current Safeguard
may e found i Exhibit A , a long the city
plan.
089 12F
Emp 1 o g e e r I -1- a e Re e ��- 1
set ktee ,
aaje Two
HEALTH PLANS
i
The City' has l e e '1 above. a re� ": i 1. ;
experience �� ; - l Z HMOs. Td-hi � e e ?�
hea d Z- alo e 'Lk- a �e S .
KAISER N ` HEAL Ah7
, -e-� - . f " �. �l c r a a and
e Kai e r' ' ,. - r �--
.L- r coverage. The 'r tee ee:
��� ono
���..
� 14
lk
i l #
✓
�, 420-62
h an o f .. xi 1
r,aa J.. n caha g ■
CIGNA HEALTH PLANS
e"
Thek City W
TG HMOs, a e i .o
ype and individual
^ e .� 0 . The rates
iJ ...it J�. +C
i
same. Effective
October 1. the single
rate is J.-n r eaS i i . o wh -i e the f a l lv
rate i increasing 10.1"15%,
These rati..es are. ti.r i c below:
Ci rent Rate
Reel Rates
single
$154,09
$170.
ram it s
$362,29
$422.
The plan benefilZ'-s will
rertain unchanged •
HEALTH NET
The Health New rates are increasing by 12. o
for both single and
family coverages le
r Lne are el;rQile below:
r 'e � Ra ,'-e
Renewal Rates
single
$138,06
$ 1 5 5 r 0
`amily
$375.53
$423.
The plan benefits will remain nc a e .
��� ono
EmD l ov e e r ou n a e e ewca
p z ber 8, 1992
Pace Three
0
DENTAL PEAKS
new pr- --p . d den ca' l has been added � �i ��
Cho ^ of � o��i 'r , o - pay � n a t-e . The j �. F self.-
f n e denEa1 plan con ]-nue � a e.
PACIFIC COAST ADMINISTRATORS/SELF-FUNDED DENTAL PLAN
�` e Cat es � she Cam . ' self - fumed en 'a � an � _
hanJng. is deep lion i based on .e x peenee
A_ 0-1 02 aien ar yea. and assumes 4 en Z. plan of- bane i t .
T he ra L-.e s a� e Cle o..'I ed below:
CorreI -t- Ra" .e R °nawcx� a ��'
-Ln e %r 01 00 $3o. 00
The a mini tra � ion fee for e e serif i e �s deC7.reasing -o $4.00
ro1P $5,50) pe� e pl o gee per on'h t 71hi I 'o e r for ee f-
n e plans of s 3, al se e a oo p ,
SAFEGUARD HEALTH PLANS - PREPAID DENTAL COVERAGE
This present year marks the -.Ei-.E"L"-h year of a f i -- y a� a LL-.e
guarantee ith Safeguard. As o f oC - Ober 1, 1992, Safeguard will be
offer in ric e� benef-i"Es and a simplified plan s -r o re i . . ,
one -year plan design versus the non - standard, five -yea declining
cop ay design of oar Cup rent Plan). The single ra -'%-1-e will not be
�; she 1- ami � ramie will e increasing 12%, a own below:
Current Rate Renewal Rates
Bangle $ _1 2 , ;B 4 $12,84
'a 1� � $22,00 $2 . 64
The benefits summaries for the Curren C. and new Saf earl plans are
shown in Exhibit--. A.
DN C R - PREPAID DENTAL COVERAGE
Effective October 1, 1992, the City will be offering a second
prepaid dental plan alongside Safe ar , named Den i Care .
Den iCa 'e will provide a be:bnef its--I-ich plan, as shown n x i i � B,
while being an a di-111-ional prepaid dental carrier op�i n for City
employees. DentiCa-.rels rates are as follows:
Single $11.50
Family $2..
co
091 12 F
Employee Goup I sur-a ce Re wal
epeer 8, 2-992
Page Four
LIFEZAD&D AND LONG TERM _DTSABILITY INSURANCD
our Group life insurance has added a 1 iving reeds be n e f i C. w # i ch
allows a cove.ed employee tl-o receive up to % of them -1-if
i su- mice e e f l . ear 1 y d_ �Z-hou C �rc� as in our awe th i s gear . our
long- e ni sa l i� . insurance tes re `Ea. unchanged.
STANDARD INSURANCE COMPANY
7F D &D INSURANCE
par r sur ante cox iDa nx, e a 'i -Lnz> � i
s ra oe �o pa ' or October 1 8 a � c re aced liar aye . L-e t
oc sober 1, 1992"L
.o $11 oo
AD:D s . o f oo
STANDARD INSURANCE COMPA Y - LONG TERM DISABILITY
an ar su' a ce company has rsur e she City for Long Ter
Disability e e i is s 1976, the Fire Benevole Assoc,-_, is 4C-_ ion
and the Police 0ff1cers Association each hold heir own Long Ter
Disability policies.
The rates for she plans will -1-emain the same as asp year. The
rere • ra yes are outlined below:
Management-: .64% of payroll
SAGA
-
130 Day: $ . o mp oyee o �
- 60 Day: $13.00/Employee/Month
The SACEA rates are billeld on a per employee basis to accom o awe
the negotiation process.
The City crre �y pays E full premium for the management play:
and for the SAC EA 130 day waiting period plan. A A employees
voluntarily elecLt-i g she 60 day wailting waiting period plan pay $2.00 o�
the additional $4. 30 per month.
���'
092
Employee Group Insurance Renewcals
September 8, 1992
Page Five
FISCAL IMPACT
The projected annual cos mss, assuming akc . ive enrollment as o� July,
�9 2 , are de-'C---ailed be lots# ;
It
.
$1156'.31480,00
Health Net: 11615,262-0
Se l IF- - Funded Dena.: 22-0196-1.00
including adminis�ration)
Safeguard Dental: 179,691,00
199221993
$1, 527, 971, 00
,147.0
l f g7, 93 .
238,893.00
139, 677
Deiare: A 60(330.00
Life & AD&D 1071254,00 141,576,00
Long Term D i s ab i t 'Cy: 14 3..'1-088 ._ 0 202,112400
TOTAL $5,500,959,00 $5,992,544,00
*Assure 3 of reap. (Safeguard) enrollment for 1993 plan year,
as new prepaid plan.
The annual cost of each plan may vary depending o
1 ) Changes mace during the Annual Open Enrollment in
September; and
2 Monthly fluctuations in enrollment,
Retirees, who Pad' the cost of coverage, are not included in the
annual cost es irta es. In addition, the Police officers
Association (P OA) is not included in the Medical and Dental.
projections. The City contributes to the POA medical and dental
plans through another account, Finally, both the Police Officers
Association and Fire Benevolent Association are excluded from Long
Term Disability (LTD) due to each of these two
associations carrying their own LTD plans.
Employee Group Insurance Renewals
f Pt emb e r 8 19 9
Page Six
7,unds in the amount.. � o $5 r 992 t 544 are budgeted and available
Personnel Services Employee Bene� �� account no, - 177 .
mit Fra i
ALL' rervices reor el
APPROVED o FUNDS AND CCoLTNI S
Rod Coloma
Execs wive Director
Finance & Mgmt. Services Agency
City of Santa kna
*a Exhibit A -
Safeauard Prepaid Dental Plan
..... ...
100 S-Z
Sxfeguar -Year Plaz (Current PIRu" x
1 C*%
F uar
100
00 7?-
1
Extractionr: Kingtr,-
100%
100%
100%
mlivn
P
'et •
Y
YcAr
Yca r
Year 4
-Y
100%
T
u r
P V
vJ e .
-Y
1 130 X& M
300%
100%.
100 6C
100 5�
10 0 5r.-
PIZ PaTirl'o
10 IV,
100%
100%.
100 FC'
100
0
100 5rr
100
100 5�
100% 100%.
1009,
Rd tit iia'6'* + +
1005ro
w:
single, imalgam
100 S-Z
100%
1 C*%
100
00 7?-
1
Extractionr: Kingtr,-
100%
100%
100%
100%
100%
j 009;
1MP'1W*0n: soft lisgut
10-0 5;
100%
100%
100%
100%
u r
i
Acrylic C-Town
4T
-Y
100%
rr ID rpm
ILPPLW4 th PNU.
PIZ PaTirl'o
a PPLI*
it
S75
$75
PorceWn Crown
1005ro
w:
C—V
Gingiveetomy per quadrant 100% 100% 1 W 100% 100%
WU
Molar l00%-, icy t00% IGO% % 100 nr
I 100
plop' -1. —
+ +
_kt,
�Iv'! 4%>
. .........
Full banded: oUd 5500* MOW S500* 5500* SLOW
miult r 18MO) (same) 4 it rn it,) SLOW
Start-up Foo.c none none none none 5200
V� V
OuL of ATcz Up to S50 - no charge Up to $50
no charge
Emplovep, S12.84 512.84
F a MAY 522-00 524-64
4i- '�A .....
P
of year& Rate cxpirr, October 092 YC,'3 n
W- I
FuU orlho6ontk. treatment is limited to -3 v1siti during tbc, fint 12 months of orthodonfi r- Lreatmcnt at no char gc. , and 421 offjccl
Yisitz c h 12 month period thcreaftr-r A, no chargr,- off= visits ifl ex of thosc, limits arc charged at the t e- of S20-00
4
por offlor, visit. The maximum number of visiu per oacb 12 month peFnod of adhodantk, treatment is It.
Not.-.: Currently, there is a one-y"r mrahing period for orthodontic treamcnt- Therc. will nt--it be. R waiting pmiod cinder the nc-%v
plan, cffc-ct-ivc October 1, 1992
095 12F
City of Santa Ana
- Exhibit B
DentiCare Prepaid Dental Phan
Lab reimbursement
12
F 096
,, L�
n ti Car
X-Rav
o
Cleaning
100%
_ �.
.. _ ..•4•.. ..fir
Fillings. Single amalgam
100%
Extractions: single
10096
Impaction: soft tissue
o- S•'.4 {.+t #.�__+ = _ti•ar•r *'f iJ` {... ',it #.. ..•.. ..+.,_T - -- ark.
T t __ . +l,•. .._
+r.:..t. .- .= .'...,T ___ ... .' r
+fir /i. to - + "'
Acrylic Croce
520*
Porcelain
r +r. = {-r.. {ry:... ti.T -� • + *4� .a +f�`�• + -•r {. - ... ti•..± "rr� +`C.'�
. f ��Y Yii lit \ "..__ T�... +, ..a -. +. l•' --T , .t'l.•,•.' #.';'
'- � .., + - +r + -
#.- .'. +..i. .. ,r - .+ a+
Glaglve,:to y per quadrant
100
f #�+<] �.Tr •t 44ta -.� _ �•+ •t + +a+{ •� ,+ i +. . +1 •ti.
t {�7i;:i.LiJ•,S J.'_a +a.•r' + -• }+ .. .. .. ...... .. ..• } .i.,�'
- ., J•� ..+.�,T _ t .SL1'r.•
.4Vi':.'.i
" }: -• ++•
:fl. ti
bw
},
T •. ••j +•++'•+_+ j.
�. r *ST .�.. + #' '.ST.
Molar
$60
rj:r v4r ••k'.". .a -...a ..'. rrJr � ..r + +. {. tii.i i•f l #
7! 7�_ a ...t -- �. " {.S,•F�±...`i`t . +t' +•.',ti= :' -•~f r' #a'a 1lLfTr'•L`.••r
■iY' J e•.__ �. *•- a. +.�-- .y {lYh " {-kar
+f .l .1 .LTJL r_`. titifi. .. r, =t.... .... _
+•l. ".- - - 4. _•.'l.4`__' + +..
ti.• ti -.` =.J •..ti.±T+ J- -• rT{ • .4 =. .. .f:•
Full bande4. chili
Ano
$166
adult
1 M
Start -up ea:
Vane's
iif •+'•S *.+. f ±T - -,_..- . a4J l% faY+._., r•#T Lr+.,..' r.•rti.1.•_ +.l_S`_'+!•!a {'.Lr.+i S'ti....•.
.t !�j. 'r "a.... 4•..'... •r y ___ ..; -�... }.. -'4 tilt
• ti���+ • i a•'- +; '7�'f= � 7+ • -`r =_ _ `rra a"....: J.•r.'� -�11:. +1'r_t
3 -r.' -- 1= .-Tr_`r `, .•r.r• +.i','.',ti�• +'�1 at�.':...s
.t��.- •k- ,4' #- ti` -ti}�1 � -�.• . -� }..
f_.•r_t
• {-.vr {..'..•r
.s•.t' +'r
.._ + +___ .._ , .. __ ,
_ __,
.. •' +.. • .. - T. •'.�. .+•" "-vT �••
:T: r, -_ � + . , t a v:
F. ,"} f ., ..... !. =_ +'l.�i = L" -L"J,F .:•r: fr *+
Out of Ares
up to
:... r -'r -X l,'r r , ". -
"r.•
t ffa.:i ".4 ".ill: ', ,... � � ,
Ff.. Jl.`.`- -- : rt
.y4�.T aFa .. r.. -_ --- '- " -.: }.• -ti's_, •. .�''J' +. -.: l.i� }l a• +_ +_ r.t ..'___,4i f''ti'_ -' �-•.::._
�1� .!_•_•_'+'- •+;/ }aSLS'Jl }L "i +tT, {444__:_:- ". ",; ".. ". .. Y
t1 r }r�• _ .- T .'fT Jt l.tirYr= lli.`�
rIR'.`f_+' ; l.'!.•l.*
� .{.��.'..raita. " {{f.'. "�T.'r +a- + ____. L_.....
-_ -, "� � __ _ ,... ... � " -�
�. *� - 4•r L* } .
-.. "r.ti'. {•} fl - "{ :.� r •i
' * -. ... .iAJ.': .': }_ti, .S'.ti`2'hw'.Vf� �t_�
.+`�'•". _ - ".5 rt_4• }i - -. +. •f._ _ . + \:-
- ;- w:'.•rl rl +• Y4+'r�r- ti`_t.•f �:
a f} .c'., _
.Sya,Y.,ti'. J. t.`+ "r •.:::. J.`__ }r.'_..•!. '.'++ + +*
. r_ti'. L•= .Tr.' 4 _ _ _ _ _ _ rll' - " -'_ ..:.L �2
Employee
to ee
$11.
mi if
If send Propaid carrier
Rates remain,
50 e ' H aun,
{a• *_�.• *... ... •r + .a. ":- ,'.4+'••�� �T„'...__- T•r ".4 r.T.. �. ?. .'..- ".'. ".`_4•_
]]jja�'yy r ■y��ii . "l.4`: ST }rt 4.4r J.4L4•f. =`_'.
... r_ •,r.' -. _ ...
. T +- +,.a: ±. --.. + �_
_ _ }�� .�, ._._ ,.,.. .-s-.r err,
of Yea h
year
-,• {_ "+• ■J4�if71.r�t�i rr�]r �._ w4"_* ".1' } }.Si�`J+' +++`+i.L ".4:5 "r.• }F!T 'TS .. .. +. .4.. __ _. .,. aa.a"
of dental offices
69
of dentists
Lab reimbursement
12
F 096
,, L�