DTXLM20.DOC – Patient Info Verification

September 9, 2010

Patricia Abbott

608 S 500 W

Murray, UT 84123

 

Dear Patricia,

We are in the process of updating your file and would like to verify the information we currently have.

 

Home Phone

Work Phone

Employer

 

 

Primary Insurance

Remaining Benefit

Last Visit Date

Last Payment

Account Balance

375-1586

J.C. Penneys

300 University Mall

Orem, UT 84057

224-1311

Connecticut General

1420.00

08/10/2010

50.00 02/28/2002

52.00

If you see any errors in the above, please call us to ensure that our records are correct.

Sincerely,

 

 

Dennis D. Smith, D.D.S