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FORM 8-A
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FOR REGISTRATION OF CERTAIN CLASSES OF
SECURITIES PURSUANT TO SECTION 12(B)
OR (G) OF THE
SECURITIES EXCHANGE ACT OF 1934
COAST DENTAL SERVICES, INC.
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(Exact name of registrant as specified in its charter)
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<S> <C>
DELAWARE 59-3136131
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(State of incorporation (IRS Employer
or organization Identification No.)
25400 U.S. HIGHWAY 19 NORTH
SUITE 225
CLEARWATER, FLORIDA 34623
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(Address of principal executive offices) (Zip Code)
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Securities to be registered pursuant to Section 12(b) of the Act:
<TABLE>
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TITLE OF EACH CLASS NAME OF EACH EXCHANGE ON WHICH
TO BE SO REGISTERED EACH CLASS IS TO BE REGISTERED
<S> <C>
None None
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If this Form relates to the registration of a class of debt securities and is
effective upon filing pursuant to General Instruction A.(c)(1), please check
the following box. [ ]
If this Form relates to the registration of a class of debt securities and is
to become effective simultaneously with the effectiveness of a concurrent
registration statement under the Securities Act of 1933 pursuant to General
Instruction A.(c)(2), please check the following box. [ ]
Securities to be registered pursuant to Section 12(g) of the Act:
Common Stock, par value $.001 per share
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(Title of Class)
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ITEM 1. DESCRIPTION OF REGISTRANT'S SECURITIES TO BE REGISTERED.
This registration statement relates to the registration with the
Securities and Exchange Commission of shares of Common Stock, par value $.001
per share (the "Common Stock"), of Coast Dental Services, Inc., a Delaware
corporation (the "Registrant"). The description of the Common Stock to be
registered hereunder set forth under the caption "Description of Capital Stock"
at page 42 of the Registrant's Registration Statement on Form S-1, filed with
the Securities and Exchange Commission on October 7, 1996, is incorporated
herein by reference.
ITEM 2. EXHIBITS.
DESCRIPTION
1. Specimen of Certificate representing Registrant's Common
Stock. This document was filed as Exhibit 4.1 to Registrant's
Registration Statement on Form S-1, Registration No.
333-13613, filed October 7, 1996 (the "Registration
Statement") and is hereby incorporated herein by reference.
2.1 Restated Certificate of Incorporation of Registrant. This
document was filed as Exhibit 2.1 to the Registrant's
Registration Statement and is hereby incorporated by reference.
2.2 Bylaws of Registrant. This document was filed as Exhibit 2.2 to
the Registrant's Registration Statement and is hereby
incorporated by reference.
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SIGNATURE
Pursuant to the requirements of Section 12 of the Securities Exchange
Act of 1934, the Registrant has duly caused this Registration Statement to be
signed on its behalf by the undersigned hereunto duly authorized.
COAST DENTAL SERVICES, INC.
By: /s/ Dr. Terek Diasti, DVM
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Dr. Terek Diasti, DVM
Its: Chief Executive Officer
Dated: October 7, 1996
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