Invoice Dentist in Kenya Nairobi –Free Word Template Download with AI
Address: Westlands Business Park, 4th Floor, Waiyaki Way
City: Nairobi, Kenya
Phone: +254 700 123 456
Email: [email protected]
KRA PIN: P051234567Z
License No: DHA-KEN-2023-8891
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 07, 2023
Payment Status: Pending
Bill To
Patient Name: James Kamau Mwangi
ID Number: 12345678
Phone: +254 712 345 678
Email: [email protected]
Insurance Provider: Jubilee Health Insurance
Policy Number: JHI-987654321
Group ID: GRP-NAI-554
Address: Kilimani, Nairobi, Kenya
| # | Description of Dental Services | Date of Service | Qty | Unit Price (KES) | Total (KES) |
|---|---|---|---|---|---|
| 1 | Comprehensive Dental Examination & Consultation (Initial Visit) | Oct 20, 2023 | 1 | 3,500.00 | 3,500.00 |
| 2 | Full Mouth Panoramic X-Ray (OPG) & Bitewing Radiographs | Oct 20, 2023 | 1 | 4,200.00 | 4,200.00 |
| 3 | Professional Scaling and Polishing (Supra & Subgingival) | Oct 21, 2023 | 1 | 5,000.00 | 5,000.00 |
| 4 | Root Canal Treatment (RCT) - Upper Right Molar (Tooth #3) | Oct 22, 2023 | 1 | 18,500.00 | 18,500.00 |
| 5 | Composite Resin Filling (Class II Restoration) - Lower Left Premolar | Oct 23, 2023 | 1 | 6,800.00 | 6,800.00 |
| 6 | Extraction of Impacted Wisdom Tooth (Lower Right) with Sutures | Oct 24, 2023 | 1 | 12,000.00 | 12,000.00 |
| 7 | Prescription Medication: Amoxicillin 500mg & Ibuprofen 400mg | Oct 24, 2023 | 1 | 1,200.00 | 1,200.00 |
| 8 | Follow-up Consultation & Suture Removal | Oct 31, 2023 | 1 | 1,500.00 | 1,500.00 |
Payment Instructions
Please make payment within 14 days of the invoice date. Late payments may incur a 2% monthly interest charge.
Bank Transfer:
Bank: Equity Bank Kenya Ltd
Branch: Westlands Branch, Nairobi
Account Name: Nairobi Elite Dental Clinic Ltd
Account Number: 0123456789
Sort Code: 230001
M-Pesa Paybill:
Paybill Number: 522522
Account Number: INV-2023-10-045
Cheque: Payable to "Nairobi Elite Dental Clinic Ltd"
Terms and Conditions
1. This invoice is issued in accordance with the laws of Kenya and the regulations set by the Dental Practitioners Council of Kenya (DPC).
2. All dental procedures listed were performed by licensed dentists at our Nairobi clinic. Detailed clinical notes are available upon request.
3. Insurance claims have been pre-processed where applicable. Any discrepancies should be reported within 7 days.
4. VAT is charged at the standard Kenyan rate of 16% on taxable services. Exempt services are clearly marked.
5. Payment is due within 14 days. Overdue accounts may be referred to a debt collection agency.
6. For queries regarding this invoice, contact our billing department at [email protected] or call +254 700 123 456.
7. This document serves as an official receipt for tax purposes. Please retain for your records.
Authorized Signature
Dr. Sarah Wanjiku Ochieng
Lead Dentist & Clinic Manager
Received By
Date: _______________
Signature: _______________
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