Changing an office TIN

To change the TIN (tax ID number)for your office, please visit regencedental.com, then:

• Select “Providers” at the top of the page

• Click on “Tools and resources”

• Click on “Update your status”

• Clicking on “Open form” in the “Change EIN or TIN” box will take you to a DocuSign form

• On Page 5 of the form, Appendix A, place all providers’ names who will be practicing under the TIN and please include license numbers and NPIs

When changing a TIN, a Dental Agreement is needed for the new TIN. To find the Dental Agreement, go back to regencedental.com, then:

• Select “Providers”

• Scroll down to “Join our network” and click on “Get started”

• Click “Ready to get started”

• You will then see the Dental Agreement

Please include the IRS letter and an updated W9 for the new TIN.