DELTA DENTAL PREMIERParticipating Dentist Agreement • August 25th, 2008
Contract Type FiledAugust 25th, 2008THIS AGREEMENT made and entered into this day of , 20 by and between Colorado Dental Service, Inc. d/b/a Delta Dental of Colorado, as first party, hereinafter referred to as the "Corporation" and , a dentist duly and regularly licensed to practice his/her profession in the State of Colorado, as second party hereinafter referred to as the "Dentist", states the terms and conditions of Dentist’s participation in the Delta Dental Premier Program.