Dr. SDFDSF SDFDSF
ID #166
🏥 Practice Information
Practice Name:
D
Doctor Name:
Dr. SDFDSF SDFDSF
Phone:
222-333-2223
Email:
Drdavidd@matchmydentist.com
Address:
DD 94102
Zipcode:
94102
Joined Platform:
07/14/2025
📊 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: dDdD

Q: Practice Name
A: D

Q: Address
A: DD

Q: City
A: D

Q: State
A: D

Q: Zip Code
A: 94102

Q: Office Phone
A: SDFSDF

Q: First Name
A: SDFDSF

Q: Last Name
A: SDFDSF

Q: Degree
A: DDS

Q: Area of Practice
A: General Dentist

Q: Experience
A: 0-5 years

Q: Languages Spoken
A: English

Q: URL
A: https://DSFEWQ.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: Yes

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: Yes

Q: Have your hospital privileges, if any, ever been revoked, suspended, reduced, or not renewed; have disciplinary proceedings ever been instituted against you; or are any of these actions now pending with respect to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: Yes

Q: Have you ever voluntarily relinquished hospital privileges, DEA Registration, academic appointments or any other professional status while an investigation was conducted?
A: Yes

Q: Have any complaints been filed against you with a dental/professional society?
A: Yes

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: Have any professional claim settlements, not involving litigation or arbitration, been paid by you or paid on your behalf?
A: Yes

Q: Has your professional liability insurance ever been canceled or has professional liability insurance ever been denied? ®Yes ®No
A: Yes

Q: Have you ever been convicted of a felony or do you have any felony or misdemeanor charges pending (other than minor traffic offenses)?
A: Yes

Q: Do you now have or have you had a chemical dependency/substance abuse problem?
A: Yes

Q: Malpractice Document
A: View Document

Q: DEA Certificate
A: View Document

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

Q: Please type your full legal name as your electronic signature.
A: KJNHKL

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

Payment History
Doctor Timeline
Date Joined:
07/14/2025
Complaints/Notes
📝 Admin Notes