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01. Edit your delta address change form online
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How to use or fill out delta address change form with our platform
- Click ‘Get Form’ to open the delta address change form in the editor.
- Begin by filling out the 'Billing Dentist or Dental Entity Information' section. Enter your practice owner’s name, legal business name, Taxpayer Identification Number (TIN), and Business NPI (Type 2).
- In the 'Former Address' section, provide your previous practice location and mailing address. Include telephone numbers for both locations.
- Next, move to the 'New Address' section. Input your new practice location and mailing address, along with updated telephone and fax numbers.
- Complete the certification statement at the bottom of the form by signing and dating it. Ensure all information is accurate before submission.
- Finally, return the completed form via email or mail to your local Delta Dental office as specified in the instructions.
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