2006 ADA-Approved Claim Forms - Patterson Office Supplies

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/doctor’s 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 Forms, 1-Part Continuous Forms, Nonpersonalized, 9-1/2" W x 11" H, 1000/Pkg
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, Personalized, 8-1/2" W x 11" H, 500/Pkg
2006 ADA-Approved Claim Forms, 2-Part Continuous, Nonpersonalized, 9-1/2" W x 11" H, 1000/Pkg
2006 ADA-Approved Claim Forms, Laser Compatible Sheets, 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
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 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, Personalized, 8-1/2" W x 11" H, 100 Sheets/Pad; 5 Pads/Pkg
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Schedule 2 and 2N
Schedule 3, 3N, 4 and 5
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