03D2202834 CLIA NUMBER - JOHN PATTERSON DMD

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Laboratory Demographics

CLIA Number: 03D2202834

Facility Name: JOHN PATTERSON DMD

Facility Address:
3245 W RAY RD STE 6
CHANDLER, AZ
ZIP 85226
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Facility Phone Number: 480 280-6170

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1972969194

Taxonomy: 332BC3200X - Durable Medical Equipment & Medical Supplies

CLIA Record

Field Name	Field Value
CLIA Number	03D2202834
LAB Type	Practitioner Other
Facility Name	JOHN PATTERSON DMD
Street	3245 W RAY RD STE 6
City	CHANDLER
State	AZ
ZIP	85226
Phone	480 280-6170
CertificateType	4
CertificateEffectiveDate	12/1/2022
CertificateExpirationDate	11/30/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024