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N
esbitt & Associates, I
nc.
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Type of Practice
*
Sole Proprietor
Corporation
Independent Contractor
Employee
Partnership
Volunteer
Do You Own Your Practice?
*
Yes
No
Dental School Graduation Date
Do You Work Less Than 20 Hours a Week?
Yes
No
Practice Specialities
*
Required
General Dentistry
Periodontics
Oral/Maxillofacial Surgery
Endodontics
Prosthodontics
Pediatric Dentistry
Orthodontics
Public Health
Coverage Type
Claims-Made Coverage
Occurrence Coverage
Do You Perform Any of the Following Procedures?
Sleep Apnea Therapy
Implant Placement
Partially Impacted Third Molar Extractions
Fully Impacted Third Molar Extractions
Molar Endodonitcs on Permanent Teeth
Irreversible TMJ - Phase II
Do You Perform Elective Cosmetic Dermal Procedures?
Yes
No
Would You Also Need General Liability Coverage?
Yes
No
Would You Also Need Property Insurance?
Yes
No
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