Notifications
15 Hodges Mews, High Wycombe HP12 3JL, United Kingdom
Patient Name : James Carter
Patient Birth Date : 34 years old - 10 Jan 1991
Insurance Billed : WPS
Phone Number : +1 81934 71892
Service : Dental Treatment
Issue Date : 10 Jan 2025
Due Date : 25 Jan 2025
Address : 8/15 Francis street, UK 454787
| # | Product/Service | Quantity | Rate | Amount |
|---|---|---|---|---|
| 1 | Dental Treatment | 2 | $200.00 | $396.00 |
| 2 | Bed Charge | 1 | $350.00 | $365.75 |
| 3 | Consultation surgeon Fee | 1 | $399.00 | $398.90 |
| 4 | Nursing Service Fee | 4 | $100.00 | $396.00 |
Amount
$1,793.12
CGST (9%)
$18
SGST (9%)
$18
Discount (25%)
- $18
Total Amount In Words Thousand Nine Hundred Seventy Two Dollars and Forty Three Cents
Scan to the pay
Debit Card 4654 **** **** 4195
Amount $1,972.43
All charges are final and include applicable taxes, fees, and additional costs
Manager
