DELAWARE ORTHODONTIC PROVIDER AGREEMENTOrthodontic Provider Agreement • July 18th, 2017
(hereinafter referred to as ORTHODONTIST) who is licensed to practice Dentistry in the State of Delaware and Dominion Dental Services, Inc. and Dominion Dental Services USA, Inc., both Virginia Corporations (hereinafter referred to collectively as PLAN). Whenever mentioned herein, the term ORTHODONTIST shall include all employees of ORTHODONTIST, all partners, dental associates, and all staff personnel under his direct supervision and/or control.
DOMINION NATIONAL INSURANCE COMPANY NEW JERSEY ORTHODONTIC PROVIDER AGREEMENTOrthodontic Provider Agreement • November 17th, 2016
This Orthodontic Provider Agreement (the “Agreement”) is made and entered into this day of , (the “Effective Date”), by and between
DISTRICT OF COLUMBIA ORTHODONTIC PROVIDER AGREEMENTOrthodontic Provider Agreement • July 18th, 2017
This Agreement is made and entered into this day of , (year), by and between (hereinafter referred to as ORTHODONTIST) who is qualified and appropriately licensed to practice Dentistry in the District of Columbia, and Dominion Dental Services, Inc. and Dominion Dental Services USA, Inc both Virginia Corporation (hereinafter referred to collectively as a PLAN). Whenever mentioned herein, the term ORTHODONTIST shall include all employees of ORTHODONTIST, all partners, dental associates, and all staff personnel under his direct supervision and/or control. The provisions of this Agreement are to be construed according to the laws of the District of Columbia. In the event of any inconsistency between this Agreement and the terms of any coverage contract, the terms of such coverage contract shall control.
