New Provider Request

All new providers, including temporary providers, are required to complete the attached form in its entirety before they can be set up in Denticon, DentalXchange (DXC) and DoseSpot.

This information is essential to ensure proper provider setup, accurate insurance processing, and timely claim submissions, as well as to establish the necessary access for electronic prescriptions.

Please complete the attached form in its entirety and return it at your earliest convenience so we can proceed with the necessary setups.

Thank you for your cooperation!