Join our Network

Provider membership that gives you the support you need

We want to make it as easy as possible for you to provide services to our members. That’s why we help you every step of the way. You’ll receive the support needed to get quick answers and resolve issues that come up. 

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.

  1. Complete the information form (PDF)
  2. Complete the dentist application for your state: Nevada (PDF), Arizona, California, Mississippi and Utah (PDF).
  3. Return the completed forms.


    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.


Contact DDS

Monday–Friday, 8 a.m. – 4:30 p.m. (PST)