Dentist Resources

As you scroll down the page, the sections will appear in the following order:

1. DENTIST HANDBOOKS —visit the dentist portal to view the following items:

Participating Dentists’ Handbook—Delta Dental of Virginia — view this document on the dentist portal
Participating Dentists’ Handbook—Medicare Advantage — view this document on the dentist portal

2. CREDENTIALING FORMS

DEA Waiver
Delta Dental PPO Contract
Delta Dental Premier and PPO Participation Packet
Individual Practitioner Profile (IPP)
NPI Submittal
Recredentialing Packet
W-9

3. OFFICE UPDATES FORMS

Addition of Dentist — Add a participating or non-participating dentist to an existing location
Address Change — For office location changes under the same Tax ID
Additional Office — Add a location to an existing Tax ID
Facility Update — To update office information (phone number, email, office hours, etc.)
Inactive practitioner — When a dentist is no longer practicing at a particular location
New Office Information Sheet — Add a location to a new Tax ID
Tax ID Change — To transfer locations from one Tax ID to another Tax ID

4. DIRECT DEPOSIT (EFT) FORMS

Direct Deposit (EFT) Enrollment Form
Direct Deposit (EFT) Informational Flyer

5. MEDICARE ADVANTAGE — login to the dentist portal to view the following items:

Delta Dental of Virginia Medicare Advantage Compliance Plan — view this document on the dentist portal
Fraud, Waste and Abuse Attestation — view this document on the dentist portal
Fraud, Waste and Abuse Training — view this document on the dentist portal
Medicare Advantage FAQ — view this document on the dentist portal
Offshore Subcontracting Attestation Form — view this document on the dentist portal
Participating Dentists’ Handbook—Medicare Advantage — view this document on the dentist portal

6. INDIVIDUAL PLAN RESOURCES

2024 Individual Dental Plans Summary — view this document on the dentist portal
Delta Dental of Virginia — Basic Plan — view this document on the dentist portal
Delta Dental of Virginia — Classic Plan — view this document on the dentist portal
Delta Dental of Virginia — ClearPlus Plan — view this document on the dentist portal
Delta Dental of Virginia — Enhanced Plan — view this document on the dentist portal
Delta Dental of Virginia — Premium Plan — view this document on the dentist portal
Delta Dental of Virginia — Progressive Plan — view this document on the dentist portal
Order Form for Individual and Family Plan™ brochures