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5005 State Road Shaula, OH, 44004 p: (440) 9923146 F: (440) 9986932Patient Information Patient name ___ Social Security # ___ Address ___City/State/Zip ___ Phone___ Work Phone:___ Cell Phone___ Sex:
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What is ashtabula dental associates 5005?
Ashtabula dental associates 5005 is a form used for reporting dental services provided by the dental practice.
Who is required to file ashtabula dental associates 5005?
Dental practices or associates who provide dental services are required to file ashtabula dental associates 5005.
How to fill out ashtabula dental associates 5005?
Ashtabula dental associates 5005 must be filled out with the details of the dental services provided, including patient information and treatment codes.
What is the purpose of ashtabula dental associates 5005?
The purpose of ashtabula dental associates 5005 is to report and document the dental services provided by the dental practice.
What information must be reported on ashtabula dental associates 5005?
Information such as patient details, treatment codes, date of service, and provider information must be reported on ashtabula dental associates 5005.
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