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 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 interested clinicians will receive a pre-application and qualified applicants will subsequently receive a final application 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 pre-application, please e-mail

The following six steps detail the entire credentialing process:

Step 1: Interested applicant completes and submits the pre-application.
Step 2: Qualified applicant receives the final credentialing application packet.
Step 3: Applicant submits completed credentialing application along with requested documents.
Step 4: Completed application is reviewed and processed by our Credentialing Specialist to ensure the submitted application is complete and all required documents have been received.
Step 5: The completed credentialing packet is forwarded to the Dental Director and reviewed by the Credentialing Committee.
Step 6: Applicant is notified of the Credentialing Committee’s decision via e-mail and letter to address on file.

The credentialing process may take up to 60 days to verify, review, and obtain a final decision. To expedite the process, your 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 Specialist, 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, Pre-Application

To receive a password, email

Provider Credentialing, Final Application

Once the successful Pre-Application has been accepted you will receive the password for the Final Application

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Final Application

A referral is required from your dentist or physician.