Instructions
- Please download the forms at the link below and once you have completed filling the entire form, click the “Submit” button on the form. Please email all related attachments (documents) to ProviderApps@dominionnational.com.
- Please note, once you join CAQH as a new member dentist and you receive your CAQH number by completing the CAQH application, please complete and submit the form from the first link to participate with a BCBSAZ Dental network
- Please note, You can also print the forms and fax it along with attachments to: 1 (888) 345-2040.
- Have questions or need more information? Contact Provider Services at 1 (888) 271-7806.
- If you are already a CAQH Member Dentist and interested in participating with a BCBSAZ Dental Network, please click here to download the online form.
- If you are NOT a CAQH Member Dentist and interested in participating with a BCBSAZ Dental Network, please click here to download the online form.
- Not a CAQH Member Dentist and interested in joining CAQH? Please click here to complete the CAQH application.