FYI

Moving? Let us know your new practice location and mailing address as soon as possible and we will:

• Remove your former practice location/mailing address and add your new one to our system
• Contact you if the new location requires a fee schedule change
• Notify you when the changes are completed in our system

Here is more information about practice location/mailing address changes to help us work together with ease.

Where do I start?

Start with the  Notice of Address Change form on our website. This form is for use by the contracted Delta Dental practice owner (billing entity) to report practice location and mailing address changes.

Important: The Address Change form is not for adding a practice location or adding a new dentist (treating professional) to the practice location. These additions require a new, completed and signed Participating Dentist Agreement. Use the online Information Request form to obtain the Agreement.

How much advance notice does Delta Dental need for an address change?

At least 30 days, or more if possible.

Important: It’s best to wait until you receive confirmation from us that your new practice location has been updated before using it on claims. The dates you close one practice location and open another cannot overlap in our system.

Will I be notified when my former practice location is removed and my new practice location is active in your system?

Yes. We will advise you by mail or email, generally within 30 days from our receipt of your notification.

Will my current fees still apply?

Yes, as long as your new practice location is in the same geographic region as your former practice location. If not, we will contact you about a new fee schedule.

Why can’t I fill out and submit the form online?

We need an original signature on the form from the individual dentist owner of the practice (or authorized officer of the partnership/corporation/clinic). Please print the form, fill it out and email or fax it back to us.