- Contact your Provider Relations Representative to order your contract. (See DPAP100)
- Submit the following items. Any missing items may result in the return of incomplete documents or a delay in processing.
- Current state license (attach a copy)
- Malpractice/liability insurance - minimum amounts of $1 million per occurrence, $3 million aggregate (attach a copy)
- Dentist Profile Form
- Attachment A
- DEA Certificate (attach a copy)
- Provider tax ID or ownership update (This is only required when a new contract on an existing provider is required due to a tax ID or ownership updated.)