Invoice Dentist in France Marseille –Free Word Template Download with AI
Dr. Antoine Mercier, D.D.S.
15 Rue de la République, 13001 Marseille, France
Tel: +33 4 91 00 00 00 | Email: [email protected]
SIRET: 123 456 789 00012 | TVA Intracommunautaire: FR 12 123456789
Invoice Number: INV-2023-0892
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Date: October 20, 2023
Provider Information
Dr. Antoine Mercier
Specialist in Orthodontics & Cosmetic Dentistry
Registered with the Ordre National des Chirurgiens-Dentistes
Conventionné Secteur 1 (French Social Security Agreement)
Billed To
Mr. Jean-Pierre Dubois
42 Avenue du Prado
13008 Marseille, France
SS Number: 1 75 10 75 012 345 67
Complementary Insurance: Mutuelle Santé Plus
| Ref | Description of Dental Services | Code (Nomenclature) | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|---|
| 001 | Comprehensive Oral Examination and Diagnostic Consultation including panoramic radiograph analysis. | A10-1 | 1 | 25.00 | 25.00 |
| 002 | Professional Dental Prophylaxis (Scaling and Polishing) to remove plaque and tartar buildup. | A10-2 | 1 | 65.00 | 65.00 |
| 003 | Composite Resin Restoration (Tooth #36) - Class II cavity filling with aesthetic material. | A10-3 | 1 | 120.00 | 120.00 |
| 004 | Root Canal Therapy (Endodontic Treatment) for Tooth #14 including obturation. | A10-4 | 1 | 280.00 | 280.00 |
| 005 | Ceramic Crown Preparation and Temporary Crown Placement for Tooth #14. | A10-5 | 1 | 150.00 | 150.00 |
| 006 | Periapical Radiographs (X-Rays) for diagnostic purposes during treatment. | A10-6 | 3 | 12.00 | 36.00 |
| 007 | Local Anesthesia and Nitrous Oxide Sedation for patient comfort during procedures. | A10-7 | 1 | 45.00 | 45.00 |
| 008 | Follow-up Consultation and Post-Operative Care Instructions. | A10-8 | 1 | 30.00 | 30.00 |
| Subtotal (HT - Hors Taxe) | 745.00 € |
| VAT (TVA) at 20% | 149.00 € |
| Total Amount Due (TTC) | 894.00 € |
Payment Terms & Insurance Information
Payment Methods Accepted: Cash, Bank Card (Visa, Mastercard), and Direct Bank Transfer (Virement).
Bank Details: Banque Populaire du Midi | IBAN: FR76 1234 5678 9012 3456 7890 123 | BIC: BDMFRPP
French Social Security (Sécurité Sociale): This invoice is issued in accordance with the French nomenclature for dental services. Please submit this document to your local CPAM (Caisse Primaire d'Assurance Maladie) for reimbursement. The standard reimbursement rate for Sector 1 dentists is applied.
Complementary Insurance (Mutuelle): If you have a complementary health insurance plan, please forward this invoice to your provider for additional coverage. Many plans in Marseille offer direct payment options.
Payment Deadline: Payment is due within 30 days of the invoice date. Late payments may incur a penalty of 3 times the legal interest rate plus a fixed fee of €40, as per French commercial law.
This invoice serves as an official record of dental services provided by Dr. Antoine Mercier in Marseille, France. All treatments were performed in compliance with the regulations set forth by the French Ministry of Health and the Ordre National des Chirurgiens-Dentistes. The prices listed include all materials and professional fees. In the event of a dispute, the courts of Marseille shall have jurisdiction. This document is generated in accordance with Article L.441-6 of the French Commercial Code. Please retain this invoice for your personal records and for any future medical or insurance claims. For questions regarding this invoice or your dental treatment, please contact our office during business hours: Monday to Friday, 9:00 AM - 6:00 PM.
Authorized Signature
Dr. Antoine Mercier
Received and Accepted By
Mr. Jean-Pierre Dubois
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