Dental Enrollment and Credentialing

Dental Enrollment

Apply now to become a BCBSNC Dental provider:

Individual Dental Enrollment Application

Instructions: Individual Enrollment Application

Group Dental Enrollment Application

Instructions: Group Enrollment Application

W9 form with instructions

Dental Credentialing

Get an application for credentialing as a BCBSNC Dental Provider:

BCBSNC Dental Credentialing Form

Oral Surgeon

Applications and forms specific to Oral Surgeons:

Uniform Application for Oral Surgeons

Oral Surgeon Provider Application Form