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To enroll, download the Dental Provider Enrolment form, complete all required sections, sign the enrolment form, and return by fax to ESI Canada:
Fax No.: 905-712-0669
For further information, contact the Provider Claims Processing Call Centre:
Phone No.: 1-888-511-4666
Monday to Friday:
6:30 a.m. to 8:30 p.m. Eastern Time, excluding Statutory Holidays
FULL SET OF ALL ENROLMENT FORMS FOR DENTAL PROVIDERS
NIHB
Dental Claims Submission Kit
NIHB
Dental Claims Submission Kit Attachments
ESI Canada Dental Provider Enrolment Form
ESI Canada Dental Provider Enrolment Form (Sample)
NIHB
Dental Claim Form
Provider Statement - Dental (Sample)
Predetermination Confirmation Letter (Sample)
Completion of Active Orthodontic Treatment Form
Orthodontic Summary Sheet
ESI Canada Modifications to Dental Provider Information Form
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