EFTA00283635.pdf

MAR-22-2002 09:58 FROM:DR.MAGNANI TO I- • J.' HISTORICAL STATEMENT 1/1/2013 to 3/21/2013 Thomas J. Magnani D.D. Alvin Grayson D.D.S. Telephone: 7 West 51St Street 7th Floor New York NY 10019 gelk Mr. Jeff Epstein 301 East 66th Street Dohs Account Apt 10F. 3/21/2013 New York NY 10066 Date Patient iti _ • Description Charges 1/4/2013 Credits Balance Recall ral Exam 1/4/2013 Adult 40.00 40.00 1/4/2013 le & Prophy 180.00 Add P • apical X Rays i it 220.00 1/9/2013 Amalgel 2 Surface Perm. 10.00 230.00 1/29/2013 Porcelal W. Gold Crown 375.00 605.00 1/30/2013 Case mplete 900.00 1,505.00 0.00 1,505.00 Account Total 1,605.00 J i i i Patient Charges 1,506.00 Patient Payments 0.00 I PatWnt Credits 0.00 I Patient Debits 0.00 Current 30 Days 60 Days 90 Days 120+ Days Thomas J. MagnaniCIIIS Aniin . 7 West 51st Se 'mar Nev York NY 10019 EFTA00283635