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Get Medi Cal Change Form 2011-2024

Within the Same County (DHCS 9096, rev 01/11) is solely for use by dentists who are changing business locations within the same county and who meet the definition of an “individual dentist practice”, pursuant to Welfare and Institutions (W & I Code), Section 14043.26(b). “Individual dentist practice” is defined in W & I Code Section 14043.1(I)(1) as “a dentist licensed by the Dental Board of California enrolled or enrolling in Medi-Cal as an individual provider who is sole proprietor .

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