Application for an initial Medicare provider number for a dentist, dental specialist or dental prosthetist form (HW017)

Use this form to apply for an initial Medicare provider number if you are a dentist, dental specialist or dental prosthetist.

This form was formerly known as form 3301.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 26 October 2016

This information was printed Friday 9 December 2016 from humanservices.gov.au/health-professionals/forms/hw017 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.