Dental Office Profile Update

Use this form to update specific information regarding your dental office. This information is used to accurately process and pay claims. In addition, it may be used in your provider directory listing. Note: You’ll need to fill out a separate form for each office location that has changes or updates.

Tips For Using This Tool

Use this tool when:

  • You need to update general information about your office hours, languages, website, phone or fax numbers
  • Your office's physical or billing address changed
  • Your office's general or billing email changed
  • You need to report a change to your NPI number
  • You had providers leave the practice location
  • You hired new dentists at the practice location and they are already contracted at another location
  • Your tax ID number changed
  • You purchased or opened a new dental office

You may be asked to complete credentialing paperwork when:

  • You are joining the network for the first time
  • You hired new dentists at your office that have never been contracted with Delta Dental of Arizona

Questions?

Professional Relations Hours:
Monday - Friday: 7:30 A.M. - 4:30 P.M.

Toll-free Dentist Direct Line:
866.746.1834

Our mission is to create a path to better health and wellness.

©Arizona Dental Insurance Service, Inc. dba Delta Dental of Arizona.

Delta Dental of Arizona is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.

Information provided on this site is for general education purposes only and is not intended as a diagnosis, treatment or a substitute for professional medical or dental advice, diagnosis or treatment. For even more oral health information, check out the Protect My Smile library on the Delta Dental Plans Association website.