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Dental Claim Form Aimee Ziter,Department of Mental Health Redstone Building 26 Terrace Street Montpelier, VT[removed]
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Document Date: 2012-02-02 11:08:31

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File Size: 274,67 KB

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City

Provider / /

Facility

Mental Health Redstone Building / Extended Care Facility / /

/

IndustryTerm

dental services / printing / state law / /

MedicalCondition

supernumerary teeth / Auto accident Occupational illness / /

MedicalTreatment

dental surgery / Maxillofacial Surgery / /

Organization

Department of Mental Health Redstone Building / Internal Revenue Service / American Dental Association / /

/

Position

122300000X Dentist / applicable ANSI ASC X12 code list qualifier / individual dentist / actual treating dentist / treating dentist / named dentist / Dentist / General / billing dentist / /

ProvinceOrState

Vermont / /

URL

www.adacatalog.org / http /

SocialTag