Dentist Forms

Addition of Dentist — Add a participating or non-participating dentist to an existing location
Additional Office — Add a location to an existing Tax ID
New Office Information Sheet — Add a location to a new Tax ID
Address Change — When an office changes locations under the same Tax ID
Tax ID Change — To transfer locations from one Tax ID to another Tax ID
Facility Update — To update location information (phone number, email address, office hours, etc.)
Inactive Practitioner — When a dentist is no longer practicing at a particular location