Before You Begin
Please provide the following information:
1. Is the dentist you want to enroll currently a LIBERTY provider?
Yes
No/Unsure
If you are unsure, please call (888) 352-7924
2. Do you have a currently attested CAQH provider ID?
Yes
No
3. Documents you'll need before you can complete your application:
Copy of your Dental License
Copy of your DEA Certificate
Copy of your Malpractice/Tort Insurance Certificate
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