TX HHS Form 1091. First Dental Home Certification Application

The Texas Health and Human Services (HHS) issues the TX HHS Form 1091, First Dental Home Certification Application, to certify dental providers for the Texas Health Steps program. This form is designed for dentists who want to become certified as a "First Dental Home" provider, which allows them to provide comprehensive oral health care services to children.

The application requires dentists to provide their name, type of practice, and facility information, including their National Provider Identifier (NPI) number. Additionally, they must specify if their facility is a Federally Qualified Health Center (FQHC). The form also asks for office contact person details, email address, and physical office address with ZIP code and phone number.

To complete the certification process, dentists must submit the Form 1091 along with a copy of their continuing education (CE) certificate to [email protected] or fax it to 512-483-3979. This application is only necessary for providers who have not already been certified as a First Dental Home provider.