EFTA00705196.pdf

MAR-22-2002 09:58 FROM:DR.MAGNANI 2123979008 TO:16467067223 r• 1 1 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 10018 Mr. Jeff Epstein 301 East 66th Street Dole Account Apt 1OF 3/21/2013 9648 New York NY 10066 Date P "ent Description Charges 1/4/2013 Credits Balance Recall ral Exam 1/4/2013 40.00 Adult Sale & Prophy 40.00 1/4/2013 180.00 Add Per apical X Rays 220.00 1/9/2013 10.00 Amalgti 2 Surface Perm. 230.00 1/29/2013 375.00 Porcel4 1W. Gold Crown 605.00 1/30/2013 Case t mplete 900.00 1,505.00 0.00 1,505.00 Account Total 1,505.00 Patient Charges 1,505.00 Patient Payments 0.00 Patient Credits 0.00 Patient Debits 0.00 Current 60 Days ¢ 90 Days 120+ Days Thomas J. Megnani D.D.S Ahrin Grayikst D.D.S. 7 West Stet Str New York NY 10019 EFTA00705196