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Delta Dental of Virginia Small Group Enrollment Application 4818 Starkey Road, Roanoke, VA 24018 (540) 989-8000 (800) 237-6060 Fax: (540) 776-8109 (New Enrollment/Changes to Enrollment) IMPORTANT:
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Enter the specific group identification number that corresponds to the effective date group. This number may be provided to you by the organization or entity that issued the form.
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Effective date group no is a unique group number given to a specific effective date.
Anyone who is involved in a transaction where an effective date is required must file the effective date group no.
To fill out effective date group no, you need to provide the required information such as the effective date and any related details.
The purpose of effective date group no is to track and identify specific effective dates within a transaction or process.
The information reported on effective date group no includes the specific effective date and any relevant details.
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