Benefits of becoming a provider
- Publication in our online and printed directories
- High-quality, highly vetted provider membership
- Dedicated Provider Relations department
- Competitive compensation program
- Comprehensive dental administration manual
How to become a Diversified Dental provider
It’s easy—just follow these steps. And use the credentialing checklist (PDF) to keep track of what you need to send us. To be effective the 1st of the month, return the completed information to us by the 13th of the previous month.
- Complete the information form (PDF)
- Complete the dentist application for your state: Nevada (PDF), Arizona, California, Mississippi and Utah (PDF).
- Return the completed forms.
Fax
877-243-3797
Mail Diversified Dental Service, Inc.
Attn: Re-Credentialing Department
3430 E Sunrise Dr. Suite 160
Tucson, AZ 85718
Please complete one credentialing packet (see checklist) for each provider. If the provider has additional locations, complete the Additional Location Addendum form (PDF).
Diversified Dental Services (DDS) Network Credentialing policies and procedures for applicants
Applicants must complete an initial application providing general information. Applicants are also required to submit supplemental information. The application and supplemental information is reviewed for completeness and if needed, DDS will request additional information from the applicant.
The information is verified with various agencies and then reviewed under the direction of the Dental Director and/or Peer Review Committee to make the final credentialing decision. The applicant will be notified in writing of the final credentialing decision.
We require a completed application, along with:
- Clear copies of: current state(s) license, individual NPI, current federal DEA certificate, professional liability insurance, as well as your current board certificate and specialty diploma(s), if applicable.
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