EFTA00593717.pdf

FEB-13-2003 10:35 FRal:DR.VAGNANI 2123979008 TO:16467067223 P.1'3 Thomas J. Megnanl D.D.S. Alvin Grayson D.D.S. 7 West 61st Street 7th Floor New York NY 10010 Mr. Jeff Epstein 301 East 66th Street Apt 3 10F New York NY 10066 Flitryv-‘, Cate Patient Desalption 11/812013 11/8(2013 11/8/2013 11/7/2013 Svetleana Svetleane Svetleana Svetleana Recall Oral Exam Adult Scale I Prophy Bite Wings 4 Films Amalgam 2 Surface Perm. Current I 30 Days 00 Dun HISTORICAL STATEMENT 11/6/2013 to 2/12/2014 (Svetleane) Telephone: (212) 668-1090 GM Account [ 2/12/2014 9293 Charges Credits Balance 40.00 40.00 180.00 220.00 65.00 286.00 376.00 030.00 Account Total 660.00 Patient Chain 600.00 Patient Payments 0.00 Patient Credits 0.00 Patient Debits 0.00 90 Clays 120« Days moils J. lAsoneni D.D.S. ANN Ofirpon D.D.S. 7 West Mil SI M I in Floor NOW Yolk NV 1001$ (212) Gamow EFTA00593717