Get N.c. Dma: Registration Form For Dental Seminars - Ncdhhs
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the N.C. DMA: Registration Form For Dental Seminars - Ncdhhs online
Filling out the N.C. DMA: Registration Form For Dental Seminars is a straightforward process designed to facilitate your registration for dental seminars. This guide will assist you in understanding each section of the form, ensuring that users can easily complete it online with confidence.
Follow the steps to successfully complete your registration form online.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editing platform.
- Begin by entering the provider name in the designated field. Ensure accuracy as this identifies your organization.
- Next, input your Medicaid provider number. This is a unique identifier essential for processing.
- Fill in your NPI number, a critical number for national identification of healthcare providers.
- Provide your complete mailing address, including city and zip code, to ensure proper communication.
- Indicate the county in which your practice is located.
- Enter the name of the contact person for the seminar registration. This is typically someone who can answer questions regarding the registration.
- Input the contact person's email address. This will be used for any correspondence related to the seminar.
- Include a telephone number with the area code for any immediate contact needs.
- Optionally, provide a fax number if available, which may be used for additional communication.
- Indicate the number of attendees by circling either '1' or '2' in the specified area of the form.
- Specify the location where the seminar will be held by clearly entering the venue details.
- Insert the date of registration in the respective field to document your submission.
- Once all fields are completed, save your changes. You may choose to download or print the form for your records.
- Finally, send the completed form by fax to 919-851-4014 or mail it to EDS Provider Services, P.O. Box 300009, Raleigh, NC 27622.
Ready to complete your registration? Start filling out your N.C. DMA: Registration Form For Dental Seminars online today!
NC Medicaid Direct is North Carolina's health care program for NC Medicaid beneficiaries who are not enrolled in NC Medicaid Managed Care. It includes care management by Community Care of North Carolina (CCNC), the primary care case management entity for physical health services. NC Medicaid Direct services ncmedicaidplans.gov https://ncmedicaidplans.gov › nc-medicaid-direct-services ncmedicaidplans.gov https://ncmedicaidplans.gov › nc-medicaid-direct-services
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.