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.
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).