HPSM Dental Application Form
Thank you for your interest in joining HPSM’s network as a dental provider for our Medi-Cal members. To apply, fill out and submit the online application form below.
Each provider who will render services for the agency/organization, including associates and trainees, must fill out a separate application.
- The form takes about 10-15 minutes to complete: it automatically times out after 30 minutes of non-activity and cannot be saved
- After you submit your application, an HPSM Provider Services Credentialing Specialist will review your qualifications to ensure they meet HPSM’s standards for network membership
- You should hear from HPSM about the status of your application within two business days
- If you have any questions, please email email@example.com