Update your status quickly and easily online

March 22, 2024
Quick links:

If there have been any changes to your practice’s address, phone number, tax ID numbers (TINs) and practice affiliations, be sure to complete and submit the appropriate status update form as soon as possible. The forms are available electronically through DocuSign.

Up-to-date information ensures fast and accurate claims processing and helps our members locate participating providers in our online directory. Also, when information is missing or inaccurate, members may be denied care or receive unexpected bills.

Reminder: Anytime you make a change to your TIN, you will need to sign a new dental agreement. If you are changing your practice location, employer identification number (EIN) or TIN, please attach a copy of your IRS Form 147c or CP575 by clicking the paperclip icon in DocuSign.

We will notify you in writing when your request is processed. Please allow 7-10 business days for processing.