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2006 ADA-Approved Claim Forms - Patterson Office Supplies
2006 ADA-Approved Claim Forms
The 2006 form includes an entry for National Provider Identifier. Padded single sheet bond and carbonless two-part styles are available with personalization. image 0
The 2006 form includes an entry for National Provider Identifier. Padded single sheet bond and carbonless two-part styles are available with personalization. image 1
The 2006 form includes an entry for National Provider Identifier. Padded single sheet bond and carbonless two-part styles are available with personalization. image 2
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2006 ADA-Approved Claim Forms
The 2006 form includes an entry for National Provider Identifier. Padded single sheet bond and carbonless two-part styles are available with personalization.
Personalized forms allow for office/doctors information to be added in boxes 48-52A and 54-58.
If in doubt about the correct ID number to use, please consult your carrier for information. You must provide us with the correct information.
ADA Dental Claim Form is reproduced and distributed by Patterson Office Supplies under license from the American Dental Association.
Title/Description
Patterson Item #
Mfg Item #
Price
Qty
2006 ADA-Approved Claim Form, Single-Sheet Bond, Padded, Personalized, 8-1/2" W x 11" H, , 100 Sheets/Pad; 5 Pads/Pkg
2006 ADA-Approved Claim Form, Single-Sheet Bond, Padded, Personalized, 8-1/2" W x 11" H, , 100 Sheets/Pad; 5 Pads/Pkg
Patterson Office Supplies
Personalized
020-1483
33161
See My Price
2006 ADA-Approved Claim Forms, 1-Part Continuous Forms, Nonpersonalized, 9-1/2" W x 11" H, 1000/Pkg
2006 ADA-Approved Claim Forms, 1-Part Continuous Forms, Nonpersonalized, 9-1/2" W x 11" H, 1000/Pkg
Patterson Office Supplies
Nonpersonalized
020-1384
33156
See My Price
2006 ADA-Approved Claim Forms, 2-Part Carbonless Sets, Nonpersonalized, 8-1/2" W x 11" H, 500/Pkg
2006 ADA-Approved Claim Forms, 2-Part Carbonless Sets, Nonpersonalized, 8-1/2" W x 11" H, 500/Pkg
Patterson Office Supplies
Nonpersonalized
020-1541
33164
See My Price
2006 ADA-Approved Claim Forms, 2-Part Carbonless Sets, Personalized, 8-1/2" W x 11" H, 500/Pkg
2006 ADA-Approved Claim Forms, 2-Part Carbonless Sets, Personalized, 8-1/2" W x 11" H, 500/Pkg
Patterson Office Supplies
Personalized
020-1525
33163
See My Price
2006 ADA-Approved Claim Forms, 2-Part Continuous, Nonpersonalized, 9-1/2" W x 11" H, 1000/Pkg
2006 ADA-Approved Claim Forms, 2-Part Continuous, Nonpersonalized, 9-1/2" W x 11" H, 1000/Pkg
Patterson Office Supplies
Nonpersonalized
020-1400
33157
See My Price
2006 ADA-Approved Claim Forms, Laser Compatible Sheets, Nonpersonalized, 8-1/2" W x 11" H, 500/Pkg
2006 ADA-Approved Claim Forms, Laser Compatible Sheets, Nonpersonalized, 8-1/2" W x 11" H, 500/Pkg
Patterson Office Supplies
Nonpersonalized
020-1426
33158
See My Price
2006 ADA-Approved Claim Forms, OCR Red<b><i> </b></i>Single-Sheet Laser Compatible, Nonpersonalized, 8-1/2" W x 11" H, 500/Pkg
2006 ADA-Approved Claim Forms, OCR Red Single-Sheet Laser Compatible, Nonpersonalized, 8-1/2" W x 11" H, 500/Pkg
Patterson Office Supplies
Nonpersonalized with body of form printed in OCR red ink
024-2024
38651
See My Price
2006 ADA-Approved Claim Forms, Single-Sheet Bond, Padded, Nonpersonalized, 8-1/2" W x 11" H, 100 Sheets/Pad; 5 Pads/Pkg
2006 ADA-Approved Claim Forms, Single-Sheet Bond, Padded, Nonpersonalized, 8-1/2" W x 11" H, 100 Sheets/Pad; 5 Pads/Pkg
Patterson Office Supplies
Nonpersonalized
020-1509
33162
See My Price
2006 ADA-Approved Claim Forms, Single-Sheet Carbonless, Padded, Nonpersonalized, 8-1/2" W x 11" H, 100 Sheets/Pad; 5 Pads/Pkg
2006 ADA-Approved Claim Forms, Single-Sheet Carbonless, Padded, Nonpersonalized, 8-1/2" W x 11" H, 100 Sheets/Pad; 5 Pads/Pkg
Patterson Office Supplies
Nonpersonalized
020-1467
33160
See My Price
2006 ADA-Approved Claim Forms, Single-Sheet Carbonless, Padded, Personalized, 8-1/2" W x 11" H, 100 Sheets/Pad; 5 Pads/Pkg
2006 ADA-Approved Claim Forms, Single-Sheet Carbonless, Padded, Personalized, 8-1/2" W x 11" H, 100 Sheets/Pad; 5 Pads/Pkg
Patterson Office Supplies
Personalized
020-1442
33159
See My Price
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