📄 Extracted Text (360 words)
MRY-12-2011 09:50A FROM:CR THOMAS MAGNRNI 2123979008 TO:16467067223 P.1/2
i I tea_
lit HISTORICAL STATEMENT
11/22/2010 to 4/30/2011
Thom4 Magnani D.D.$ Telephone: (212) 686-1090
Alvin GI son D.D.S.
7 West:5 t Street
7th Flobr,
New Yti Y 10019
Mr. Jett stein Dale Account
301 East th Street 5/12/2011 9648
Apt 10p
, New Y,0r NY 10065
Date , 0 ription Charges Credits Balance
Previc Balance 0.00
11/22/2010 FM with Bite wi Bs 175.00 175.00
11/22/2010 Am Igam 1 Surf. e Pennl. 325.00 500.00
11/22/2010 Am Igam 3 Surf e Pemt 375.00 875.00
12/13/2010 Co p. W. Etch Surface) 275.00 1,150.00
12/13/2010 Cor p. W. Etch Surface' 275.00 1,425.00
12/14/2010 Co prehensive ral eval 50.00 1,475.00
12/14/2010 Ad I Scale & Pr hy 160.00 1,835.00
12/17/2010 MASTER CARD 1,425 00 210.00
12/20/2010 Por4elain W. Go Crown: 1,850.00 2,060.00
1/7/2011, Epoateal 'avian 2,300.00 4,360.00
1/7/2011 Epoeteal Implant 2,300.00 6,660.00
1/14/2011 Office Visit 0.00 6,660.00
1/21/2011 MA TER CARD 1,850 00 4,810.00
1/25/2011 Po elain W. Go Crown • 1,850.00 6,660.00
2/10/2011 1 P riapical X R 25.00 6,685.00
3/2/2011. Am Igam 2 Surf Pert. 375.00 7,060.00
4/21/2011 Abiment Place nt 1, 925.00 7,985.00
4/21/2011 Abutment Place nt il 925.00 8,910.00
4/21/2011 Por4elain W. Go Crown: I 1,900.00 10,810.00
Page 1 Continued
I
6015ps 120+ Days
Thoma onant0.0.5 Aisle Grayson D.D.S4 7 Mat 51st Snot( New Yore NY 10019 (212)688.1090
EFTA01107466
MAY-12-2011 09:51A FROM: CR THOMAS HAGNANI 2123979008 TO:16467067223 P.2'2
1I
I
HISTORICAL STATEMENT
11/22/2010 to 4/30/2011
Thonlia, Magnanl D.D.S. Telephone: (212) 688-1090
Alvin qr son D.D.S.
7 West 5 t Street
7th Flop
New ycir, , NY 10019
Mr. Jeff stein Date Account
301 Elf th Street 5/12/2011 9648
Apt 10
New Yti NY 10065
Date . P ient D option - li Charges Credits Balance
4/21/2011 Por elain W. Go Crown. 1,900.00 12,710.00
t 1
i I
Ef
i
t Ii
I
E
Page 2 I Account Total 12,710.00
i Patient Charges 15,986.00
I Patient Payments 3,275.00-
Patient Credits 0.00
Patient Debits 0.00
Current 30 Days 60 Days 1 90 Days 120+ Days
Thomatst,I. nani D.D S ANIGtayson D.D S 7 West Slat Stroot Fle I New York NY 10019 (212)888.1090
EFTA01107467
ℹ️ Document Details
SHA-256
b55f727f962f3d8b496ea8d0c5df3d395de977594698e6817bc248f20d9f187f
Bates Number
EFTA01107466
Dataset
DataSet-9
Document Type
document
Pages
2
Comments 0