How does a provider of dental services obtain a Denti-Cal provider number?

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How does a provider of dental services obtain a Denti-Cal provider number?

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To receive a Denti-Cal provider number, the appropriate application package must be submitted. For example, a dentist new to Denti-Cal must submit a Medi-Cal Provider Application (form DHCS 6204), a Medi-Cal Disclosure Statement (form DHCS 6207), and the required attachments, including a copy of a driver’s license or state-issued identification card, a copy of his/her dental license, a copy of the certificates of insurance coverage and professional liability insurance coverage, and other documentation as listed on the DHCS 6204.

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