Become a Provider
Providers: Join The Health Net Dental Network
Step 1
Please complete, sign, and date a Provider Credentialing Application (PDF)
(required for all practicing Dentists and Associates)
Step 2
Please submit current credentials (required for all practicing Dentists and Associates).
General Dentist
- Wallet size Dental License
- DEA Certificate
- Professional Liability
- W-9 form (PDF)
Specialists
Please also submit Specialty Certificate(s)
Step 3
Mail forms to:
Provider Relations
340 Commerce, Suite 100
Irvine, CA 92602