Invoice Dentist in Nigeria Abuja –Free Word Template Download with AI
15 Aguiyi Ironsi Street, Maitama District
Abuja, FCT, Nigeria
Phone: +234 803 456 7890
Email: [email protected]
TIN: 12345678-0001
Invoice Number: APDC-2024-0892
Date Issued: October 15, 2024
Due Date: October 30, 2024
Payment Status: Pending
Bill To:
Patient Name: Mrs. Amina Ibrahim
Address: 42 Cadastral Zone A0, Asokoro District
City: Abuja, FCT, Nigeria
Phone: +234 805 123 4567
Email: [email protected]
Patient ID: APDC-PAT-4521
| Description of Dental Services | Procedure Code | Date of Service | Quantity | Unit Price (NGN) | Total (NGN) |
|---|---|---|---|---|---|
| Comprehensive Dental Examination and Consultation | D0150 | October 10, 2024 | 1 | 15,000.00 | 15,000.00 |
| Full Mouth Digital X-Rays (Panoramic) | D0330 | October 10, 2024 | 1 | 25,000.00 | 25,000.00 |
| Professional Dental Cleaning (Prophylaxis) | D1110 | October 10, 2024 | 1 | 20,000.00 | 20,000.00 |
| Root Canal Therapy - Upper Right Molar | D3330 | October 12, 2024 | 1 | 85,000.00 | 85,000.00 |
| Porcelain Crown Placement - Upper Right Molar | D2750 | October 14, 2024 | 1 | 120,000.00 | 120,000.00 |
| Composite Filling - Lower Left Premolar | D2391 | October 14, 2024 | 1 | 35,000.00 | 35,000.00 |
| Follow-up Consultation and Treatment Assessment | D0140 | October 15, 2024 | 1 | 10,000.00 | 10,000.00 |
| Subtotal: | ₦310,000.00 |
| Value Added Tax (7.5%): | ₦23,250.00 |
| Insurance Adjustment: | -₦50,000.00 |
| Total Amount Due: | ₦283,250.00 |
Payment Instructions
Please remit payment within 15 days of the invoice date to avoid late fees. Our clinic accepts the following payment methods:
Bank Transfer:
Bank Name: First Bank of Nigeria
Account Name: Abuja Premier Dental Clinic Ltd.
Account Number: 1234567890
Sort Code: 011000001
Online Payment:
Visit our secure payment portal at: payments.abujapremierdental.ng
Cash Payment:
Accepted at our clinic reception during business hours (Monday-Friday: 8:00 AM - 6:00 PM, Saturday: 9:00 AM - 2:00 PM)
Please include your Invoice Number (APDC-2024-0892) as the payment reference.
Important Notes:
1. This invoice is issued in accordance with the Federal Inland Revenue Service (FIRS) regulations for healthcare providers in Nigeria.
2. All dental procedures listed were performed by licensed dentists registered with the Dental Council of Nigeria.
3. Late payments will incur a penalty of 2% per month on the outstanding balance after the due date.
4. Please retain this invoice for your records and for insurance reimbursement purposes.
5. If you have any questions regarding this invoice or your dental treatment, please contact our billing department at +234 803 456 7890 or email [email protected].
6. Our clinic is committed to providing high-quality dental care in Abuja, Nigeria, and we appreciate your trust in our services.
7. This document serves as an official receipt upon confirmation of payment.
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