Dentist Credentialing Checklist

Dental degree diploma (DDS or DMD) Required

Current state dental license (all states where practicing) Required

DEA certificate (current and valid) Required

NPI number confirmation Required

CAQH ProView profile (completed and attested) Required

Current malpractice insurance certificate (face sheet) Required

Dental specialty board certification (if applicable) Optional

Sedation / anesthesia permit (if applicable) Optional

CPR / BLS certification (current) Required

Curriculum vitae / resume (up to date, no gaps) Required

Professional references (minimum 3 peer references) Required

Government-issued photo ID (driver's license or passport) Required

Signed attestation questionnaire Required

Proof of professional liability coverage Required

Dental residency completion certificate (if applicable) Optional

W-9 form (completed and signed) Required

Practice location details (address, phone, fax, hours) Required