Complete the form to request your Provider’s Most recent Effective Date from Principal INSURANCE FEE MAXIMIZATION Principal: Most Recent Effective Date Request PRACTICE INFORMATION: Practice Name (required) Name of Contact Submitting Request (required) Email of Contact Submitting Request (required) Phone Number of Contact Submitting Request (required) PROVIDER REQUESTING ACTION: First Name of Dentist (required) Middle Name of Dentist Last Name of Dentist (required) Specialty (required) ---General DentistDental AnesthetistEndodontistOral Maxillofacial SurgeonOrthodontistPediatric DentistPeriodontistProsthodontist Provider NPI# (required) Provider Tax ID Number/TIN (required) Once submitted, the request will be sent to Principal for your Provider's Most Recent Effective Date. You will receive an email from Principal with this information.