Sample report. The provider below is fictional and used for illustration only. Any resemblance to a real person is coincidental.

Provider Background Report

Prepared by Vetera · Report ID: VTR-SAMPLE-001 · Date: May 2026

1. Provider Identification

Name	Dr. Jane A. Sample, DMD
Profession	Dentist — Oral & Maxillofacial Surgery
Primary Practice	123 Example Blvd, Sample City, FL 33000
Florida License #	DN00000
NPI	0000000000

2. License Status

✓ Active — Clear. License is current and in good standing as of report date.

Issued: March 2008
Expires: February 2028
Restrictions: None
Source: FL DOH MQA License Verification

3. Disciplinary History

⚠ 1 disciplinary action on record.

Date	Type	Summary	Resolution
2019-04-12	Board of Dentistry	Failure to maintain adequate patient records on three patients between 2017–2018.	Administrative fine of $3,500 and required 12 hours of continuing education in records management. Case closed 2019-09-30.

Source: Florida Board of Dentistry Enforcement Actions Database

4. Sedation & Anesthesia Authorization

✓ Active permit — General Anesthesia.

Permit type: General Anesthesia Permit (Florida)
Issued: 2010
Last renewal: 2024
Restrictions or suspensions: None reported
Source: FL Board of Dentistry Anesthesia Permit Roster

5. Public Complaints & Settlements

✓ No formal public complaints on file.

Note: Private settlements not part of board action are not publicly disclosed and may not appear.

6. Court Filings (Florida State Courts)

⚠ 2 civil filings located.

Year	County	Case Type	Status
2021	Broward	Civil — alleged dental malpractice	Dismissed with prejudice 2022
2023	Miami-Dade	Civil — fee dispute (patient billing)	Settled out of court, terms sealed

Sources: Broward County Clerk of Courts, Miami-Dade Clerk of Courts

7. Federal Sanctions

✓ No federal sanctions found.

OIG List of Excluded Individuals/Entities (LEIE): Not listed
GSA System for Award Management (SAM) exclusions: Not listed
DEA registration: Active, no public actions

8. Summary & Color-Coded Risk Indicators

License	Clear
Discipline	1 minor action (records)
Sedation Authority	Clear
Complaints	None on file
Court Filings	2 civil cases (1 dismissed, 1 settled)
Federal Sanctions	None

9. Methodology & Sources

This report is compiled exclusively from public records available through Florida state and federal government databases. All findings are factual statements with citation links to original sources. Vetera does not provide opinions, recommendations, or clinical interpretations. Patients should discuss findings with their healthcare team or an attorney when appropriate.

Data current as of report date. Records can change after the report is delivered.