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Get Delta Dental Notice of Address Change

Ail when your practice location and mailing address are updated in our system, generally within 30 days from our receipt of this form. Please do not use your new address on claims until you receive confirmation from us that your address has been updated. If your new practice address is in the same geographic region as your former address, your current contracted fees will apply. However, if your new practice address is in a different geographic region, we will contact you about new fee schedule(.

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