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Dental Application Form Provider Registration Form Completion Guide (223 KB) Medical Provisionally Licensed Physicians Policy / Approval to Bill Fee for Service APPLICATION INSTRUCTIONS FOR FILING A CLINIC LICENSE APPLICATION Section A Clinic Application & Processing Fee Bureau of Indian Affairs Official:

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Dental Application Form Provider Registration Form Completion Guide (223 KB) Medical Provisionally Licensed Physicians Policy / Approval to Bill Fee for Service If your dental provider does not know, you can contact FNHA Health Benefits office at 1.800.317.7878 and ask to speak with the dental benefit staff.

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