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Joining the DenteMax network online is quick and easy; it only takes a few minutes. Soon you will have access to thousands of new patients in your area who need a quality dentist like you.
 

To view and print our Provider Services Agreement, Dental Office Information Sheet and Participating Dentists Application, just click the "Download" button below. You will need Adobe Acrobat Reader in order to view this application. Click Here to download the reader.

Or if you would like to save this application locally, right click the "Download" button and select "Save Target As" to download our Provider Services Agreement, Dental Office Information Sheet and Participating Dentists Application:

 

 

 
 

Complete the Information Sheet Application and sign the Provider Service Agreement. Fax or mail these documents, along with a copy of your state license, DEA certificate, specialty certificate (if applicable) and proof of professional liability insurance to:

 

DenteMax
Provider Relations
28588 Northwestern Highway
Suite 450
Southfield MI 48034
Fax: 248-327-9201

 
If you have any questions please call our
 Provider Relations Department at 1-800-752-1547.
 
 
    
 
 
 
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