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  How To Become a Participating Provider


Thousands of dental offices have found that joining our PPO panel is easy and financially beneficial to their practices. To become a network provider, please print & complete the Provider Agreement form and W-9 form and mail them with the following items to our Provider Relations Department: (For more information please refer to Provider Forms)

Copies of your (and your Associates')

  • Copy of the Wallet-size dental license
  • Copy of the DEA license
  • Copy of the CPR
  • Copy of the Malpractice Insurance declarations page

Mail to:

Premier Access Insurance Company
Attn: Provider Relations Department
P.O. Box 659010,
Sacramento, CA 95865-9010

For more information about this plan, please Contact Us

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