Provider Application


Thank you for your interest in becoming a Capitol Dental Care Preferred Provider! As a Dental Care Organization (DCO) under the Oregon Health Plan (OHP), we are required to credential each dentist  prior to providing services to our members. As with any government program, the OHP has a certain amount of paperwork that needs to be completed.

Beginning January 1, 2016, in compliance with state regulation, Capitol Dental Care will be using the Oregon Provider Credentialing and Re-credentialing Applications (OPCA/OPRA) for all providers. This is a change from the previous applications. The applications can be found at the links listed below. These applications do not address some information requested by our Coordinated Care Organization (CCO) partners, the supplemental Provider Intake form addresses that additional information needed.

CDC Supplemental information

Provider Attestation and Release

Provider Intake Form

Provider Application

Oregon Provider Credentialing Application

Oregon Provider Recredentialing Application

Along with the completed paperwork above, please submit the following items:

o Copy of your current Oregon dental license.
o Copy of your current Oregon DEA Certificate (if applicable).
o Copy of your current Malpractice Insurance Certificate.

Certificate must include provider name, policy effective/expiration dates and per occurrence/aggregate amounts.

Please email paperwork or any inquiries to: