Medicare Advantage amendment to participating dentist agreementParticipating Dentist Agreement • March 4th, 2015
This Amendment (hereinafter the “Amendment”) to the Participating Dentist Agreement (hereinafter the “Agreement”) is made a part of and supplements the Agreement entered into by dentist and Delta
Participating Dentist AgreementParticipating Dentist Agreement • February 5th, 2024
This Agreement (“Agreement”) is between Dentist and Delta Dental of Virginia. It is effective on the date that Delta Dental of Virginia accepts it (as evidenced by Delta Dental of Virginia's entry to that effect on the last page of the Agreement) and will remain in effect until either party terminates it in the manner provided for in the “Termination” section of the “Terms and Conditions” attachment. This Agreement applies specifically to Delta Dental of
Participating Dentist Agreement Government ProgramsParticipating Dentist Agreement • January 3rd, 2024
This Participating Dentist Agreement (this “Agreement”) is between Oregon Dental Service, an Oregon nonprofit corporation (“ODS”), and the undersigned dentist, who is a duly licensed dentist in his/her
DeltaCare Orthodontic Services Participating Dentist AgreementParticipating Dentist Agreement • September 10th, 2020 • Delta
This Agreement (“Agreement”) is between Dentist and Delta Dental of Virginia. It is effective on the date that Delta Dental of Virginia accepts it (as evidenced by Delta Dental of Virginia’s entry to that effect on the last page of the Agreement) and will remain in effect until either party terminates it in the manner provided for in the “Termination” section of the “Terms and Conditions” attachment. This Agreement applies specifically to Delta Dental of Virginia’s DeltaCare® Orthodontic Services program. With respect to DeltaCare Enrollees, the terms and conditions in this Agreement control and supersede any contradictory provision(s) in the “Terms and Conditions” attachment.
Participating Dentist AgreementParticipating Dentist Agreement • March 4th, 2015
This Agreement (“Agreement”) is between Dentist and Delta Dental of Virginia (DDVA). It is effective on the date that DDVA accepts it (as evidenced by DDVA’s entry to that effect on the last page of the Agreement) and will remain in effect until either party terminates it in the manner provided for in the “Termination” section of the “Terms and Conditions” attachment. This Agreement applies specifically to DDVA’s Delta Dental PPO program. With respect to Delta Dental PPO Enrollees, the terms and conditions in this Agreement control and supersede any contradictory provisions in the “Terms and Conditions” attachment.
DeltaCare Primary Dental Services Participating Dentist AgreementParticipating Dentist Agreement • September 10th, 2020
This Agreement (“Agreement”) is between Dentist and Delta Dental of Virginia. It is effective on the date that Delta Dental of Virginia accepts it (as evidenced by Delta Dental of Virginia’s entry to that effect on the last page of the Agreement) and will remain in effect until either party terminates it in the manner provided for in the “Termination” section of the “Terms and Conditions” attachment. This Agreement applies specifically to Delta Dental of Virginia’s DeltaCare® program. With respect to DeltaCare Enrollees, the terms and conditions in this Agreement control and supersede any contradictory provision(s) in the “Terms and Conditions” attachment.
Participating Dentist Agreement with United Concordia Companies, Inc. for the Department of Defense (DoD) ProgramsParticipating Dentist Agreement • December 14th, 2022
Under 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 Department of Defense (DoD) Networks (i.e. Active Duty Dental Program (ADDP) Network and/or TRICARE Dental Program (TDP) Network) of United Concordia Companies, Inc. and its affiliates (collectively, “United Concordia”), I (“Dentist”) do hereby agree as follows:
ContractParticipating Dentist Agreement • February 19th, 2021
This document supplements the Delta Dental Premier program Participating Dentist Agreement between Delta Dental of Tennessee (DDTN) and the Dentist and states the terms of the Dentist’s participation in DDTN’s Delta Dental PPO (PPO) Program (i.e. a program administered by DDTN or any other Delta Dental in which a dentist has contracted to provide care at fees that are, in most cases, below the fees charged in the Delta Dental Premier Program).
DeltaCare Specialist Dental Services Participating Dentist AgreementParticipating Dentist Agreement • September 10th, 2020 • Virginia
This Agreement (“Agreement”) is between Dentist and Delta Dental of Virginia. It is effective on the date that Delta Dental of Virginia accepts it (as evidenced by Delta Dental of Virginia’s entry to that effect on the last page of the Agreement) and will remain in effect until either party terminates it in the manner provided for in the “Termination” section of the “Terms and Conditions” attachment. This Agreement applies specifically to Delta Dental of Virginia’s DeltaCare® program. With respect to DeltaCare Enrollees, the terms and conditions in this Agreement control and supersede any contradictory provision(s) in the “Terms and Conditions” attachment.
Participating Dentist Agreement with United Concordia Companies, Inc.Participating Dentist Agreement • January 12th, 2012
Under 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:
PARTICIPATING DENTIST AGREEMENTParticipating Dentist Agreement • September 4th, 2019 • Rhode Island
This Participating Dentist Agreement is made and entered into as of the Effective Date set forth below by and between Delta Dental of Rhode Island (“Delta Dental”) and the following participating dentist (“the Dentist”).
PARTICIPATING DENTIST AGREEMENTParticipating Dentist Agreement • August 25th, 2008
THIS 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 “Dentist”, states the terms and conditions of Dentist’s participation in the Delta Dental PPO program.
DeCare Dental EncompassSM PARTICIPATING DENTIST AGREEMENTParticipating Dentist Agreement • December 11th, 2006 • Maine
This AGREEMENT is made this day of , by and between DeCare Dental Encompass sponsored by DeCare Dental Networks, LLC, (hereinafter DDN) a Minnesota limited liability company having its principle place of business at 3560 Delta Dental Drive, Eagan, Minnesota, 55122, and the undersigned dentist (hereinafter Dentist).
AMENDMENT TO PARTICIPATING DENTIST AGREEMENT – GHP PROGRAMParticipating Dentist Agreement • September 11th, 2018
This document constitutes an amendment to the Participating Dentist Agreement (“Dentist Agreement”) previously entered into by Delta Dental of Puerto Rico, Inc. (“DDPR”) and the participating dentist(s) or dental group whose name(s) appear(s) below (“Participating Dentist” or “Dentist” or “Provider”). This Amendment shall become effective on the date it is signed by Dentist.
Participating Dentist AgreementParticipating Dentist Agreement • May 1st, 2015
This Amended Schedule of Dental Care Service Fees to the Participating Dentist Agreement (also referred to as Exhibit A in the Participating Dentist Agreement) with Plan 200 Series benefits shall be effective as of June 01, 2017. This Amended Schedule supercedes and replaces any and all previous Schedules of Dental Care Service Fees to the Participating Dentist Agreement for Plan 205. Dentist shall charge Members no more than eighty percent (80%) of Dentist’s normal charge for any dental care service. Dentist may require Member to pay for dental care services in accordance with the Agreement at the time service is rendered. Dentist is not obligated to charge Members any specified rates for dental care service performed by Dentist after Member’s membership in the Aon Dental Solutions is terminated.
Participating Dentist AgreementParticipating Dentist Agreement • June 30th, 2015
This Schedule of Vision Care Service Fees for Members shall be attached as page one of Exhibit A to the Participating Vision Agreement (the “Agreement”) dated , 20 , by and between Aon Vision Solutions and (“Provider”). Provider shall provide vision care services to Members with benefits for the following fees in accordance with the following terms and conditions.
Participating Dentist AgreementParticipating Dentist Agreement • May 1st, 2015
This Amended Schedule of Dental Care Service Fees to the Participating Dentist Agreement (also referred to as Exhibit A in the Participating Dentist Agreement) with Plan 200 Series benefits shall be effective as of February 1, 2019. This Amended Schedule supercedes and replaces any and all previous Schedules of Dental Care Service Fees to the Participating Dentist Agreement for Plan 205. Dentist shall charge Members no more than eighty percent (80%) of Dentist’s normal charge for any dental care service. Dentist may require Member to pay for dental care services in accordance with the Agreement at the time service is rendered. Dentist is not obligated to charge Members any specified rates for dental care service performed by Dentist after Member’s membership in the Aon Dental Solutions is terminated.
PARTICIPATING DENTIST AGREEMENTParticipating Dentist Agreement • June 15th, 2009
This Agreement (“Agreement”) is entered into, on this day of 2009, between the undersigned dentist (“Participating Dentist or a Participating Group Practice”) and
DELTA DENTALParticipating Dentist Agreement • February 25th, 2009
THIS 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 Child Health Plan Plus Program, hereinafter referred to as CHP+.
ANTHEM BLUE CROSS PARTICIPATING DENTIST AGREEMENT – SPECIALISTParticipating Dentist Agreement • March 22nd, 2010 • California
This Anthem Blue Cross Participating Dentist Agreement is between Anthem Blue Cross (hereinafter “Anthem Blue Cross”) and the dentist or dental entity signing this Agreement (hereinafter “Dentist”).
DELTA DENTAL PREMIERParticipating Dentist Agreement • August 25th, 2008
THIS 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.
SUPPLEMENT TO THE PARTICIPATING DENTIST AGREEMENTParticipating Dentist Agreement • June 1st, 2022
This Supplement (hereinafter the “Supplement”) to the Participating Dentist Agreement (hereinafter the “Agreement”) is made a part of and supplements the Agreement entered into by provider and Delta Dental of Tennessee, Inc. (“Delta Dental”)1 . Dentist agrees that in addition to the terms and conditions and Program Requirements as defined and set forth in the Agreement with Delta Dental of Tennessee , Dentist will comply with the following regulatory requirements for any Enrollees that are covered under a Delta Dental Medicare Advantage dental plan. Please note, as identified below some additional regulatory requirements may only apply to certain types of dental plans.
Delta Dental of Colorado Participating Dentist Agreement Summary Disclosure FormParticipating Dentist Agreement • August 24th, 2008
As required by C.R.S. 25-37-101, Health Care Contracts – Required Provisions, subsection (3), paragraph (a), this summary disclosure form is for informational purposes only and shall not be a term or condition of the contract. This summary disclosure form summarizes the applicable contract provisions.
Contract of Affiliation - Participating Dentist’s AgreementParticipating Dentist Agreement • August 26th, 2022
(Practice-site) this is a student's place of employment where they are supervised by their employer, the participating dentist agree to:
Participating Dentist Agreement with United Concordia Companies, Inc.Participating Dentist Agreement • November 20th, 2006
Under the applicable laws of the State of Virginia, 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:
