Provider Forms

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Provider Forms

The following are the forms available for providers:

Provider Dispute Resolution Mechanism
Provider Agreement
Associate Information
Dentist Handbook
Request for Taxpayer Identification Number and Certification (W9) Form
Dental Claim Form

Note: In order to use these forms you need the Adobe Acrobat Reader installed on your computer.
To get Acrobat, just click on the "Get Acrobat Reader" button