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DOMINION DENTAL SERVICES, INC. AND DOMINION DENTAL SERVICES USA, INC. MARYLAND ORTHODONTIC PROVIDER AGREEMENT This Agreement is made and entered into this day of, (year), by and between (hereinafter
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Step 1: Download the Maryland Orthodontic Provider Agreement from the official website.
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Step 2: Read the agreement thoroughly to understand the terms and conditions.
03
Step 3: Fill in your personal information such as name, address, and contact details.
04
Step 4: Provide your professional information including your license number and any relevant certifications.
05
Step 5: Review the agreement again to ensure all the required sections are completed.
06
Step 6: Sign the agreement and include the date of signing.
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Step 7: Make a copy of the signed agreement for your records.
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Step 8: Submit the completed agreement to the appropriate authority or organization as instructed.

Who needs maryland orthodontic provider agreement?

01
Any orthodontic provider practicing in Maryland needs the Maryland Orthodontic Provider Agreement. This includes orthodontists, dentists specializing in orthodontics, and other dental professionals providing orthodontic treatments. It ensures compliance with the regulations and standards set by the state of Maryland for orthodontic providers.
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The Maryland orthodontic provider agreement is a contract between a healthcare provider and an insurance company to provide orthodontic services.
All orthodontic providers in Maryland who wish to provide services covered by insurance companies are required to file the agreement.
The provider must fill out the agreement with their contact information, services provided, billing information, and any other required details specified by the insurance company.
The purpose of the agreement is to establish a formal partnership between the healthcare provider and the insurance company for the provision of orthodontic services.
The agreement must include provider details, services offered, billing information, and any other specific requirements outlined by the insurance company.
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