Practice for Sale Information
Company/Practice Name
Contact Name
Contact Title
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
Phone
Fax
Email
Type Of Practice
General
Endodontics
Oral Surgery
Orthodontics
Pedodontics
Periodontics
Prosthodontics
Size of Practice
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 your used our services 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
Other Source:
