Adding a New Location or Updating an Existing Location?

• Dentist First & Last Name
• MO License Number
• Tax ID Number
• Updated or New Address
• Effective Date
• Completed W-9 Form attached
• Corporate Authority

Add Additional Networks

Annual Medicare Attestation

A Quick Note About the First Time Credentialing Process

• When Delta Dental of Missouri (DDMO) receives your Initial Credentialing application the approval process can take up to 60 days.
• Providers should keep the following in mind if they decide to see DDMO members prior to credentialing approval:
  
  • Claims will be processed as non-participating.
  • DDMO does not back-date the approval (effective) date of the credentialing application.
    
• You may log into DDS Enroll at any time and view the progress of your application and/or upload any outstanding items that DDMO may request to complete your application.