Contract with MCNA Dental

We are very pleased to announce that MCNA Dental was selected by the Idaho Department of Health and Welfare (IDHW) to administer its Idaho Smiles Medicaid dental program statewide. We invite you to join our network of general and specialized oral health practitioners. MCNA Dental is a provider friendly program. The key to our success has been our relationships with our providers in each region.

Provider Enrollment

Our electronic contracting and credentialing process makes it easy to enroll with MCNA Dental.

Alternatively, you may choose to fill out all credentialing application documents on paper and mail them to MCNA Dental. Please download, print, and complete the documents below. (Adobe Reader may be required to view PDF files.)

  • Step 1: Download and read our Provider Welcome Letter.
  • Step 2: Download and complete one New Provider Form for each dentist.
  • Step 3: Download and complete one New Location Form for each physical location.
  • Step 4: Download and complete our Dental Provider Agreement which includes a Fee Schedule. (Denturists click here for the Denturist Agreement.)
  • Step 5: Download and complete the IRS W-9 Form for each physical location.
  • Step 6: Download and complete the Payment Method Selection Form for each physical location.
  • Step 7: Fax the completed documents to 1-877-563-8560, email them to (file attachment limit of 10MB total per email), or mail them to:

    MCNA Dental
    Attn: Idaho Network Development
    P.O. Box 740370
    Atlanta, GA 30374-0370

Providers who participate with CAQH can provide MCNA Dental with their CAQH number to access credentialing documentation.

Other/Optional Credentialing Forms

Click each link below to download the forms. Adobe Reader may be required to view these PDF files.

For More Information or For Questions

Click here to contact MCNA Dental's Idaho Provider Hotline. You may also contact us by email for an online response at

Frequently Asked Questions for Providers

Click here to view a list of frequently asked questions about becoming an MCNA Dental provider for the Idaho enrollees.