Adding a New Office or Changing Your TIN

To add a new office location, add an existing network provider to an existing location or to change your tax ID number (TIN),

Recredentialing with Delta Dental of Arizona

Per national insurance guidelines, we ask our dentists to recredential every 3 years. When it's time to recredential, your office will receive a letter in the mail and an email from credentialing@dentalxchange.com. The following documents are required to recredential:

1. Arizona Health Care Professional Credentials Application
• Complete all fields on the online app. Do NOT leave anything blank!
• Anything left blank will be returned to you for completion.
• You may note "N/A", if appropriate
2. Arizona Dental License
3. Specialty Certification and/or Anesthesia Permit, if applicable
4. Drug Enforcement Administration (DEA) and (BNDD) Registration, if applicable
5. Current Malpractice Insurance Declaration Page for your dental liability coverage,
   The declaration page must show your:
• Name
• Policy number
• Coverage amounts
• Dates of coverage

Becoming a Delta Dental Network Dentist

When you are contracting/credentialing for the first time with Delta Dental of Arizona, you will need to upload current versions of the following documents:

1. Delta Dental of Arizona Participating Provider Agreement
2. Arizona Health Care Professional Credentials Application
• Complete all fields on the online app. Do NOT leave anything blank!
• Anything left blank will be returned to you for completion
• You may note "N/A", if appropriate
3. Arizona Dental License
4. Specialty Certification and/or Anesthesia Permit, if applicable
5. Drug Enforcement Administration (DEA) and (BNDD) Registration, if applicable
6. Current Malpractice Insurance Declaration Page for your dental liability coverage,
   The declaration page must show your:
• Name
• Policy number
• Coverage amounts
• Dates of coverage