EFTA02700249

FEB-13-2003 10:36 FROM:DR.MENANI TO: P.3'3 Thomas J. Magnanl D.D.B. Alvin Grayson D.D.B. 7 West 51st thritet 7th Floor New York NY 10019 Mr. Jeff Epstein P.O. Box 808 New York NY 10150 Date Patient Description 1/22/2014 1/28/2014 1/25/2014 Bleaching Trap Recall Oral Exam Adult Scale S Prophy Currant 30 Days 80 Deye HISTORICAL STATES' 1/1/2014 to 2/12/2014 Telephone: Dote Accoul 2/12/2014 10348 Charges Credits Balance 950.00 toso.00 40.00 990.00 180.00 1,170.00 Account Total 1,170.00 Patient Charges 1,170.00 Patient Payments 0.00 Patient Credits 0.00 Patient Debits 0.00 90 Days 120+ Days Thomas J. klignani D.0.5 Alvin &neon D.D.B. 7 West Mettle Tth Floor New York NY 10019 EFTA_R1_02065527 EFTA02700249