Who can sign the enrollment application package?
The package must be signed by the dental provider who is the sole proprietor, partner, corporate officer or an official representative of a governmental entity or non-profit organization, who has the authority to legally bind the applicant seeking enrollment as a Denti-Cal provider. A biller or office manager is not a valid signatory. Include a legible, current copy of the driver’s license or state-issued identification card number of the authorized person signing the application. Enlarged copies work best.
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