Update your practice information

Delta Dental processes claims, mails checks and sends other materials to you based on the dental information in our records. This information also appears in our printed and online directories that our members use to find dental offices near their home or place of business.

Please let us know immediately of any changes to the following information:

• Addition or deletion of a dentist in your practice
• Tax Identification Number and legal name for IRS form 1099
• Office location/address
• Mailing address for payment
• Phone number for patients to call to make an appointment
• Fax and email
• Owner changes and practice sale
• Directory attributes such as appointment availability, languages spoken, office hours, etc.

To give you our best service, Delta Dental must have accurate, up-to-date practice information. If you are not sure if your practice information is current, check the Dentist Information section on your Explanation of Benefits statement. Failure to keep your practice information current in our records may result in your claims being delayed or denied.

To report changes:

• Fill out our address change form to update your payment and/or service office address
• Fill out this form to update your TIN information
• Once complete, submit your updated information:
• Fax: 973-285-4192
• Email as an attachment