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Professional Relations Department
HDSProfessionalRelations@HawaiiDentalService.com
8085299222; toll-free 8663767500 ext 222
Fax 8085299223INACTIVATE PROVIDERClear FormPrintBusiness Entity/Payee Name:
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How to fill out inactive provider form4doc
How to fill out inactive provider form4doc
01
Obtain the inactive provider form4doc from the appropriate department or office.
02
Fill in all necessary personal information, such as name, provider ID, and contact details.
03
Indicate the reason for becoming an inactive provider.
04
Submit the completed form to the designated person or office for processing.
Who needs inactive provider form4doc?
01
Healthcare providers who wish to temporarily suspend their services or take a leave of absence may need the inactive provider form4doc.
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What is inactive provider form4doc?
Inactive provider form4doc is a form used to report providers who are no longer actively practicing or providing services.
Who is required to file inactive provider form4doc?
Inactive provider form4doc is required to be filed by providers who are no longer actively practicing or providing services.
How to fill out inactive provider form4doc?
To fill out inactive provider form4doc, providers must include their personal information, details on their inactive status, and any other required information.
What is the purpose of inactive provider form4doc?
The purpose of inactive provider form4doc is to inform the relevant authorities that a provider is no longer actively practicing or providing services.
What information must be reported on inactive provider form4doc?
Inactive provider form4doc must include the provider's personal information, details on their inactive status, and any other required information.
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