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SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
FORM 10-C
REPORT BY ISSUER OF SECURITIES QUOTED ON NASDAQ
INTER-DEALER QUOTATION SYSTEM FILED PURSUANT TO
SECTION 13 OF 15(d) OF THE SECURITIES EXCHANGE ACT
OF 1934 AND RULES 13a-17 AND 15d-17 THEREUNDER
Princeton Dental Management Corporation
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(Exact Name of Issuer as Specified in Charter)
7421 West 100th Place, Bridgeview, IL 60455
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(Address of Principal Executive Offices)
(708) 974-4000
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(Issuer's Telephone Number Including Area Code)
I. CHANGE IN NUMBER OF SHARES OUTSTANDING
Indicate any change (Increase or Decrease) of five percent or more in
the number of shares outstanding:
1. Title of security Series A 11.75% Cumulative Convertible Preferred
Stock
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2. Number of shares outstanding before the change None
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3. Number of shares outstanding after the change 3,600
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4. Effective date of change August 9, 1996 (Subject to pending
issuance of certificates)
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5. Method of change:
Specify method (such as merger, acquisition, exchange, distribution,
stock split, reverse split, acquisition of stock to treasury, etc.)
Acquisition
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Give brief description of transaction: Acquisition of stock in
conjunction with a certain letter agreement dated July 15, 1996.
II. CHANGE IN NAME OF ISSUER
1. Name prior to change
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2. Name after change
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3. Effective date of charter amendment changing name
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4. Date of shareholder approval of change, if required
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Date 9/25/96 /s/ Steve Sierkowski, CFO, Secretary
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(Officer's Signature and Title)
