GANI DENTAL LAB

SRIDHAR DENTAL & GENERAL

HOSPITAL
333 D ALAGAR KOVIL ROAD
MELUR - 625106
9843771186,04522415274
Customer Information:

Name _____________________________________________ Date:_________

Address _________________________________________________________________

City _____________________________________State______________Zip__________

Phone# ____________________________ Alt Phone#____________________________

Dental Invoice Form

Qty Description

1 cercon zirconia (6 x 5000) 30000

Gum shade (6 x 500 )
impression , consultation fee

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Subtotal
25 years warranty is provided for zirconia cercon
crown and bridge work Paid

Total Due