EFTA02700327.pdf

FEB-13-2003 10 35 FROM:OR.WMANI TO: P.1'3 -ttd: Il& HISTORICAL STATEMENT 11/6/2013 to 2112/2014 Thomas .1. Magnin, D.D.B. Telephone: Alvin Grayson Milt 7 West 61st Stint 7th Floor New York NY 10010 Mr. Jeff Epstein DS AtOount 301 East 66th Street I 2/12/2014 9293 Apt 310F New York NY 10065 Cate Patient Deacripdon Charges Credits Balance 11/6/2013 Svetleana Recall Oral Exam 40.00 40.00 11/8/2013 Svetleana Adult Scale & Prophy 180.00 220.00 11/6/2013 Svetleana Bite Wings 4 Films 66.00 285.00 urfaoe Perm. 376.00 880.00 Account Total 660.00 Patent Charges 610.00 Patient Payments 0.00 Patient Credits 0.00 Patient Debits 0.00 Current 30 Days 80 Dee 90 Cloys 120+ Days Thomas. Moonain AMn orintyoon 0.0.8 7 Woof Mot Si et 791 Floor Now Yolk NY 19019 EFTA_R1_02065815 EFTA02700327