03D2174266 CLIA NUMBER - MIDWESTERN UNIV COLLEGE DENTAL MEDICINE

Laboratory Demographics

  • CLIA Code: 03D2174266
  • Facility Name: MIDWESTERN UNIV COLLEGE DENTAL MEDICINE
  • Facility Address: 5855 W UTOPIA RD
    GLENDALE, AZ
    ZIP 85308
  • Facility Phone: 623 806-7000
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: DOUGLAS BEALS
  • NPI Number: 1114692423
  • Taxonomy: 152WV0400X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 03D2174266
LAB Type School/Student Health Service
Facility Name MIDWESTERN UNIV COLLEGE DENTAL MEDICINE
Street 5855 W UTOPIA RD
City GLENDALE
State AZ
ZIP 85308
Phone 623 806-7000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type School/Student Health Service
Lab Director DOUGLAS BEALS

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This page was last updated on: 9/29/2025