Participating Dentist Agreement with United Concordia Companies, Inc.Participating Dentist Agreement • January 12th, 2012
Contract Type FiledJanuary 12th, 2012Under the applicable laws of the State of , I am duly authorized to engage in the practice of dentistry. In consideration for being registered as a participating dentist in the Fee for Service Dental Network (the “Network”) of United Concordia Companies, Inc. and its affiliates (collectively, “United Concordia”), I (“Dentist”) do hereby agree as follows: