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WORKERS UNITED CANADA BENEFITS TRUST FUND Send This Claim To: DENTAL CLAIM FORM 11061 International Blvd. Toronto, ON M9W 6K4 Phone: 4166743350 18004614361 PART 1 DENTIST Name P A T Address I E N
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What is dental claim form?
The dental claim form is a document used to request reimbursement for dental services provided.
Who is required to file dental claim form?
Patients who have received dental services and wish to be reimbursed for the cost are required to file a dental claim form.
How to fill out dental claim form?
To fill out a dental claim form, you will need to provide your personal information, details of the dental services received, and any associated costs.
What is the purpose of dental claim form?
The purpose of the dental claim form is to request reimbursement for dental services from the insurance company.
What information must be reported on dental claim form?
The dental claim form should include the patient's name, contact information, insurance policy number, details of the dental services provided, and the total cost.
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