Dr. Terry Bradshaw
ID #143
🏥 Practice Information
Practice Name:
Kjhkjhkjh
Doctor Name:
Dr. Terry Bradshaw
Phone:
234-523-4543
Email:
Demo5@matchmydentist.com
Address:
Kkjhkhjk 84665
Zipcode:
84665
Joined Platform:
06/14/2025
📊 Performance Metrics
Total Matches:
0 patients
Completed Appts:
0
Patient No-Shows:
0
Patients Refused:
0
Cancelled by Pt:
0
Total Earnings:
$0.00 (0 × $399)
Account Status:
✅ Active
📋 Detailed Information
Recent Patient Matches
Original Questionnaire Responses
Q: Office Email
A: dfeg

Q: Practice Name
A: kjhkjhkjh

Q: Address
A: kkjhkhjk

Q: City
A: kjhkjh

Q: State
A: kjhkjhk

Q: Zip Code
A: 84665

Q: Degree
A: DDS

Q: Area of Practice
A: General Dentist

Q: Experience
A: 0-5 years

Q: Languages Spoken
A: Spanish

Q: First Name
A: terry

Q: Last Name
A: Bradshaw

Q: How many new patients are you looking for monthly?
A: 16-30 new patients

Q: Ready to Start Receiving Matches?
A: I have questions before getting started

Q: URL
A: https://ewrfgwre.com

Q: Has your license to practice in this state or any other state been denied, restricted, limited, suspended or revoked; have you ever been reprimanded by a state licensing agency; or are any of these actions pending with respect to your license?
A: No

Q: Has your DEA Registration ever been restricted, limited, suspended or revoked, or are any of these actions pending with respect to your DEA Registration?
A: No

Q: Have your hospital privileges, if any, ever been revoked, suspended, reduced, or not renewed; have disciplinary proceedings ever been instituted against you; or are any of these actions now pending with respect to your hospital privileges?
A: No

Q: Have you ever voluntarily relinquished hospital privileges, DEA Registration, academic appointments or any other professional status while an investigation was conducted?
A: No

Q: Have any complaints been filed against you with a dental/professional society?
A: No

Q: Have any professional liability judgments been entered against you, including arbitration awards or are there professional liability suits currently pending against you?
A: Yes

Q: Please type your full legal name as your electronic signature.
A: wedfew hjg j

Q: By clicking "I accept" below, you agree to the above certification terms and conditions and consent to electronic signature
A: Yes

Q: Only the doctor may complete and certify this form. Are you the doctor personally completing this form?
A: Yes

Payment History
Doctor Timeline
Date Joined:
06/14/2025
Complaints/Notes
📝 Admin Notes