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Provider Interest Form Provider Name: DBA: Specialty: Primary Address: City Zip: County: Office Phone: Office Fax: Contact Person: Contact Phone: Contact Email: Hospital Affiliations: Satellite Location(s)
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What is provider name dba?
Provider name doing business as (dba) is a name used by a person or entity that is different from the legal name of the business.
Who is required to file provider name dba?
Any individual or business that operates under a name different from their legal name is required to file a dba.
How to fill out provider name dba?
To fill out a dba, one must typically submit a registration form with the appropriate government agency and pay any required fees.
What is the purpose of provider name dba?
The purpose of a dba is to allow businesses to operate under a name that is different from their legal name, providing flexibility and branding opportunities.
What information must be reported on provider name dba?
The information required for a dba filing may vary by jurisdiction, but typically includes the legal name of the business, the dba name, and contact information.
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