Your Tax Identification Number (TIN, EIN or SSN)

Did you know that your TIN and practice name on file with Delta Dental must match IRS records exactly? If they do not, the IRS requires us to withhold 28 percent of the dollars owed to you from future payments until the matter is resolved.

To verify that we have the right TIN on file for you, review the next payment check you receive from Delta Dental. Compare the TIN on the check to your name or the business name and associated TIN that the IRS has on file for you. If the TINs do not match, notify us immediately.

Please submit a new TIN form when you:

• Add a new practice location
• Make any changes to your tax identification number or type of business entity, such as a partnership or corporation
• Open or close an office location
• Change your name
• Change your address
• Buy or sell a practice

TIN Tips

• If two or more names are used (such as Chris James, DMD, dba Market Street Dental), please report to Delta Dental the first name that appears on the IRS records.
• If you are unsure of how your practice name and the associated TIN are recorded with the IRS, check what is printed on the mailing labels that are supplied by the IRS for quarterly tax payments. Or, you may contact the IRS to request a letter (#147C) that will confirm its record of your name and TIN. The IRS phone number is 800-829-1040.