Thomas J. Magnani D.D.S. Telephone
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Mr. Jeff Epstein Date
9 East 71st Street V29/2015
New York NY 10021
IMPORTANT. PLEASE DETACH UPPER PORTION AND RETURN WIN YOUR REMITTANCE
TO INSURE CREDIT TO PROPER ACCOUNT
Date Patient Description Charges Credits
7/1/2015 ' lance
7/1/2015 40.00
7/1/2015 180.00
Account Total
If payment has been sent, please disregard this statement - Thank You.
We accept credit cards! You may complete and return the top part of
this statement, or call the office at 212-688-1090.
Current 30 Days 60 Days 90 Days 1
220.00 0.00 0.00 0.00
Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7111 Floor New York NY 10019 (212) 688
EFTA_R1_02114333
EFTA02709159