Practice For Sale

Company Information

Dentist/Practice Name  

Contact Name (if different from practice)

Address

Address

City   

State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip

Main Phone

Fax 

E-mail address

Practice Information

Type of practice  General Endodontics Oral Surgery Orthodontics Pedodontics Periodontics Prosthodontics

How Many:   RDH's      DA's      Operatories  

Average Number of Patients Daily  

Fee for service %       Capitation %     Medicaid %  

How old is the practice? 

Gross Revenues

Number of Active Patients 

Asking Price 

How modern is the equipment? 

Have you used our service before?  Yes No Not Sure -Choose-

How did you hear about us?  -Other- AltaVista Conference/Symposium Excite Friend Infoseek/GO Look Smart Lycos MSN Newspaper Radio Advertisement Yahoo Yellow Pages
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