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Join our network
Provider membership that gives you the
support you need

We make it easy to serve our members by providing support every step of the way. Our team is available to
answer questions and help resolve issues quickly.
Benefits of becoming a DDS providerFeatured in our online and printed provider directoriesMembership in a high-quality, carefully vetted provider networkSupport from a dedicated provider relations teamCompetitive compensationAccess to a comprehensive dental administration manual
How to become a DDS provider

Getting started is easy. Follow the steps below and use the credentialing checklist (PDF) to track the information you need to submit. To become effective on the first day of the month, return all completed materials by the 13th of the previous month.

Step 1
Complete the information form

Step 2

Complete the dentist application for your state:
Nevada (PDF) Arizona, California, Mississippi and Utah (PDF)

Step 3

Return the completed forms.

Mail
Diversified Dental Service, Inc. Attn: Re-Credentialing Department 9445 Farnham Street, Suite 100 San Diego, CA 92123

FAX
877-243-3797

Please complete one credentialing packet (see checklist) for each provider. If the provider has additional locations, complete the Additional Location Addendum form (PDF).
DDS network credentialing policies and procedures for applicants

Complete the application and submit any required supporting documents. We'll review your materials for completeness and may contact you if additional information is needed. Once your information is verified and reviewed by the dental director and/or peer review committee, we'll notify you in writing of the credentialing decision.

In addition to a completed application, please provide copies of your:

Current state license(s)Individual NPICurrent DEA certificateProfessional liability insuranceBoard certification and specialty diploma(s), if applicable

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