What information is required to be submitted with each Maryland Uniform Dental Credentialing Form?
The following items must be submitted with each Maryland Uniform Dental Credentialing Form: • Copy of DEA registration certificate, if applicable; • Copy of Controlled Dangerous Substance registration issued by the State or District in which you practice, if applicable; • Copy of current professional license(s); • Copy of specialty board certification, if you are board certified; • If you are not board certified, proof of eligibility, such as copy of admission for examination or proof of successful completion of residency program. • Copy of professional liability coverage certification and must include the limits of coverage, the expiration date, and the name of the provider covered under the policy.
Related Questions
- I already submitted a CAQH Universal Credentialing Datasource application, do I need to complete a Maryland Uniform Dental Credentialing Form also?
- Where do I send the completed Maryland Uniform Dental Credentialing Form and Dental Billing Authorization Form?
- What information is required to be submitted with each Maryland Uniform Dental Credentialing Form?
