Get Md Uniform Dental Credentialing Form 2008-2025

The MD Uniform Dental Credentialing Form is essential for dental professionals seeking to establish their credentials electronically. This guide offers comprehensive instructions for completing the form accurately and efficiently, ensuring a smooth processing experience.

Follow the steps to fill out the MD Uniform Dental Credentialing Form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin with Section 1, where you will provide personal information and professional identifiers. Ensure to include your full legal name and any previous names. Remember that fields marked with an asterisk (*) require mandatory responses.
3. Input your demographic details such as date of birth, gender, and contact information, including preferred contact methods, ensuring legibility and accuracy in the specified fields.
4. Move to the Professional IDs section where you need to provide all relevant licensing information, including state licenses, DEA registration, and certification numbers. If you are a participating Medicaid provider, indicate this here as well.
5. Complete Section 2 on Education and Training, detailing all institutions attended, degrees earned, and your start and end dates. Ensure to use the appropriate codes provided on the code lists.
6. In Section 3, provide details about your primary and secondary specialties. Specify whether you wish to be listed in directories under these specialties and provide certification dates if applicable.
7. For Section 4, list your primary practice location and include contact information for the practice. Indicate if you accept new patients and specify office hours.
8. Continue to fill out Sections 5 through 8, where you'll provide information about hospital affiliations, professional liability insurance, work history, and disclose any potential issues related to licensure or professional conduct.
9. Once all sections are completed, review your entries for accuracy. Save your changes, and you can choose to download, print, or share the completed form as required.

Begin your credentialing process and complete the MD Uniform Dental Credentialing Form online today.