📄 Extracted Text (152 words)
STATEMENT
Thomas J. Magnani D.D.S. Telephone:
Alvin Grayson D.D.S.
7 West 51st Street PrArt9 by aeon cant enter NM amount you mre paving A he ermlwAt L'OX and
•Oul below
7th Floor Mysiercad Vise krou
New York NY 10019
Cads E xp OM*
Sinaboo Si9 CNN
New York NY 10019
Dabs
4/19/2012
IMPORTANT • Pt EASE DETACH UPPER PORTION AND RETURN WITH YOUR REMITTANCE TO INSURE CREDIT 70 PROPER ACCOUNT
Account
Remittance
1
Date Patient Description Charges Credits Balance
Previous Balance 0.00
4/18/2012 1 Periapical X Ray 25.00 25.00
4/18/2012 Amalgam 2 Surface Perm. 375.00 400.00
Account Total 400.00
We accept credit cards You may complete and return the top part of
this statement, or call the office at
Current 30 Days 60 Days 90 Days 120+ Days
400.00 0.00 0.00 0.00 0.00
Thomas J Magram D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019
EFTA_R1_02059707
EFTA02698720
ℹ️ Document Details
SHA-256
c20b7b29c7d98cfa3c0a4634026d90710bc3046a08b71dcb6c714e172b8e7b8e
Bates Number
EFTA02698720
Dataset
DataSet-11
Document Type
document
Pages
1
Comments 0