Credentialing Information & Process

We appreciate your interest in becoming a credentialed provider at Lakeside Dental Surgery Center. Prior to beginning your service with the facility, you must complete our credentialing process and be approved by our credentialing committee. Our credentialing policy is compliant with AAAHC accreditation standards.

Our credentialing applies to Dentists, Physicians, CRNAs, and AAs (licensed independent healthcare practitioners) who wish to provide services at Lakeside Dental Surgery Center. All qualified and interested clinicians will submit an application to be reviewed for clinical privileges. We have streamlined our process and will make every effort to process your application in a timely and efficient manner, with excellent communication.

To request a password for access to the Credentialing Application, please e-mail:


The following steps detail the entire credentialing process:

Step 1: Interested applicants complete and submit the application and requested documents. When using the online version of the application, you are able to save your progress and return to the draft application at any time to complete and submit.

Step 2: Submitted applications and documentation will be reviewed for accuracy by the credentialing team.

Step 3: Completed applications for qualified applicants will be sent to the Medical Advisory Committee for review and recommendation.

Step 4: Upon recommendation from the Medical Advisory Committee, the application will then be forwarded to the Governing Body for final approval.

Step 5: Applicant is notified of the Governing Body’s decision via e-mail and letter to the address on file.

The credentialing process may take up to 60 days to verify, review, and obtain a final decision. To expedite the process, the application should be without blanks or missing requested documents; if anything is missing, the process will be delayed.

If at any time you or your practice leadership have questions regarding the credentialing process, please contact the credentialing team, administrator, or dental director at the contact information below. Our goal is to assist you and your practice while ensuring that we are compliant with the Accreditation Association for Ambulatory Health Care (AAAHC) and other relevant guidelines.

Lindsey Bohannon
Credentialing Specialist


Provider Credentialing Application

To receive a password, email

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A referral is required from your dentist or physician.