Dentists

Forms & Resources

New to Delta Dental?
If you would like to become a participating dentist with Delta Dental of Rhode Island, just fill out the forms below, sign them and send them to us via fax or regular mail. You can download and print copies of these forms as needed.

Already participating?
If you are already participating with Delta Dental of Rhode Island, this page may be useful to you when you need to add a new dentist to your practice, or to update your office status. You can also view the current and archived Details newsletters here.

The Delta Dental payer ID number is 05029.

Application Documents

Credentialing Committee Meeting Schedule
If you are new to Delta Dental, you must first be credentialed. Delta Dental also re-credentials participating dentists every three years.

Enrollment Checklist
This list details all the forms you need to submit your application package.

Dentist Application
Fill out your application here. You can type directly on the document then print it out, or print it out and fill it in manually.

W9 Form
We need this form to be able to pay your fees.

Rules & Regulations
This is a list of requirements that dentists must follow to be able to participate with Delta Dental of Rhode Island.

Provider Contract
Here is your contract. Please submit two signed copies with your application package.

Participating Dentist Checklist
Use this checklist for credentialing purposes.

Practice Update Forms

Office Closed
Use this form if you retire, or close your office.

Remove Location
Use this form if a dentist has left your practice.

Add Location
Use this form if a dentist has joined your practice.

Other Documents

Check Run Schedule
View our check processing dates.

Additional Resources:

NEA FastAttach
Use this tool to submit documentation electronically.