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DENTAL PROVIDER DEMOGRAPHIC CHANGE FORM High mark Blue Cross Blue Shield of Western New York PROVIDER ENROLLMENT DEPARTMENT 257 West Geneses Street Buffalo, NY 14202CONFIDENTIAL Please complete all
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How to fill out dental provider demographic change
How to fill out dental provider demographic change
01
Gather all necessary information such as practice name, provider name, and NPI.
02
Access the dental provider demographic change form.
03
Fill out all required fields accurately and completely.
04
Review the information for accuracy before submitting the form.
Who needs dental provider demographic change?
01
Dental providers who have changed their practice name, provider name, or NPI number.
02
Dental offices looking to update their information with insurance companies and regulatory agencies.
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What is dental provider demographic change?
The dental provider demographic change refers to any updates or modifications in the personal or professional information of a dental provider, such as address, contact details, or specialty.
Who is required to file dental provider demographic change?
All dental providers are required to file a dental provider demographic change whenever there is a change in their personal or professional information.
How to fill out dental provider demographic change?
Dental providers can typically fill out a dental provider demographic change form provided by their licensing board or regulatory body. They will need to fill in their updated information and submit the form as per the instructions.
What is the purpose of dental provider demographic change?
The purpose of the dental provider demographic change is to ensure that accurate and up-to-date information is maintained for all dental providers. This helps in maintaining communication, ensuring regulatory compliance, and providing accurate information to patients.
What information must be reported on dental provider demographic change?
The information that must be reported on a dental provider demographic change form may include name, address, contact details, license number, specialty, and any other relevant information that has been updated.
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