Dental Enrollment and Credentialing

Dental Enrollment

Apply now to become a Blue Cross NC Dental provider:

• Individual Dental Enrollment Application 

• Instructions: Individual Enrollment Application 

• Group Dental Enrollment Application 

• Instructions: Group Enrollment Application 

• W9 form with instructions 

Dental Credentialing

Get an application for credentialing as a Blue Cross NC Dental Provider:

• Blue Cross NC Dental Credentialing Form 

   

Oral Surgeon

Applications and forms specific to Oral Surgeons:

• Blue Cross NC Dental Credentialing Form