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Provider Training Acknowledgement – Provider Compliance Attestation

Thank you for taking LIBERTY Dental's training. Please submit the following information in order to complete your training.
 
  1. Click on the attestation document and complete the fillable form:
    Provider Training Acknowledgement – Provider Compliance Attestation

  2. Upload the completed PDF attestation form below.

  3. (OR) Print, sign the attestation, scan the signed attestation, and upload the completed attestation form below.
Upload Signed Attestation Form

Please only click Submit once

By submitting this form, I hereby certify that all persons associated with the office entered above have completed LIBERTY Dental's training for this calendar year.