📄 Extracted Text (231 words)
APR-13-2011 10:29A FROM:DR THOMAS HAGMANI 2123979008 TO:16467067223 P.1/1
HISTORICAL STATEMENT
11/22/2010 to 4/13/2011 it
Thom Telephone: (212) 688-1090
. Alvin
7W
71h Fl
New
Date Account
Mr.
301 EA 4/13/2011 9648
Apt 10
Now
Date De ription Charges Credits Balance
11/22/2010 FM with Bite wi s j I 175.00 175.00
11/22/2010 Am. gam 1 Surf Perm, 325.00 500.00
11/22/2010 Atom 3 Surf Perm, t j S 375.00 875.00
12/13/2010 Co p. W. Etch 1 urface p 275.00 1,150.00
12/13/2010 Corhip. W. Etch 1a urface j 275.00 1,425.00
12/14/2010 Co prehensive al eval i 50.00 1,475.00
12/14/2010 Adu . Scale & Pr. hy : 160.00 1,635.00
i 1,425.00 210.00
12/17/2010 MA ER CARD
12/20/2010 Por lain W. Gol Crown i k 1,850.00 2,060.00
1/7/2011 Ep teal Implant i i i 2,300.00 4,360.00
117/2011: Ep teal Implant i 2,300.00 6,660.00
1/14/2011 Off Visit 0.00 6,660.00
1/21/2011 MA TER CARD 1,850.00 4,810.00
1/25/2011 Pordelain W. Gol rown 4 1,850.00 6,660.00
2/10/2011 1 P 'apical X R ! ' 25.00 6,685.00
3/2/2011 Am ,gam 2 Surf: Perm, 375.00 7,060.00
r
,
Account Total 7,060.00
Ii
I i f.
i Patient Charges 10,336.00
I
Patient Payments 3,275.00-
ii Patient Credits 0.00
Patient Debits 0.00
Cu ent 30 Days 60 pays 90 Days 120+ Days
i
i
as J. Mr gnanl Alvin Grays D D.S. nAlest 514 Stitt Ji Floor New York NY 10019
ri
I
EFTA00621611
ℹ️ Document Details
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a5ad3a5c7cf260089bbfabb533b2142cc258a7a4fa5f19c59847eafb31c5c5ec
Bates Number
EFTA00621611
Dataset
DataSet-9
Document Type
document
Pages
1
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