Case File
efta-efta00670850DOJ Data Set 9OtherSTATEMENT
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00670850
Pages
1
Persons
0
Integrity
No Hash Available
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
STATEMENT
Thomas J. Magnani D.D.S.
Alvin Grayson D.D.S.
7 West 51st Street
7th Floor
New York NY 10019
Mr. Jeff Epstein
9 East 71st Street
New York NY 10021
Telephone
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Date
Recount
3/28/2015
10918
Remittance
NOORTANT • PLEASE DETACH UPPER PORTION AND RETURN WITH YOUR REMMNCE TO INSURE CREW TO PROPER ACCOUNT
Date
Patient
Description
Charges
Credits
Balance
2/26/2015
Previous Balance
0.00
2/26/2015
Simon
Comprehensive Oral eval
60.00
60.00
2/26/2015
Simon
Adult Scale & Prophy
180.00
240.00
2/26/2015
Simon
Fluorid
12.00
252.00
2/26/2015
Simon
FMS with Bite wings
175.00
427.00
3/2/2015
Simon
Adult Scale & Prophy
180.00
607.00
3/5/2015
Simon
Amalgam 2 Surface Perm.
450.00
1,057.00
3/5/2015
Simon
Amalgam 3 Surface Perm.
475.00
1,532.00
3/5/2015
Simon
Amalgam 2 Surface Perm.
450.00
1,982.00
3/9/2015
Simon
Amalgam 2 Surface Perm.
425.00
2,407.00
3/9/2015
Simon
Amalgam 2 Surface Perm.
425.00
2,832.00
3/17/2015
Simon
Amalgam 2 Surface Perm.
475.00
3,307.00
3/17/2015
Simon
Amalgam 3 Surface Perm.
475.00
3,782.00
3/19/2015
Simon
Amalgam 2 Surface Perm.
425.00
4,207.00
Account Total
4,207.00
if payment has been sent, please disregard this statement - Thank You.
We accept credit cards! You may complete and return the to part of
this statement, or call the office at
Current
30 Days
60 Days
4,207.00
0.00
0.00
90 Days
0.00
120+ Days
0.00
Thomas J. Magnani
AMn Grayson D.D.S.
7 West 51st Street
7th Floor
New York NY 10019
EFTA00670850
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