03D2257086 CLIA NUMBER - MESA VALLEY MODERN DENTISTRY

Laboratory Demographics

  • CLIA Code: 03D2257086
  • Facility Name: MESA VALLEY MODERN DENTISTRY
  • Facility Address: 1712 S COUNTRY CLUB DR STE 104
    MESA, AZ
    ZIP 85210
  • Facility Phone: 480 376-0593
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: RICHARD HUYNH
  • NPI Number: 1487190880
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 03D2257086
LAB Type Practitioner Other
Facility Name MESA VALLEY MODERN DENTISTRY
Street 1712 S COUNTRY CLUB DR STE 104
City MESA
State AZ
ZIP 85210
Phone 480 376-0593
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2024
Certificate Expiration Date 3/30/2026
Facility Type Practitioner Other
Lab Director RICHARD HUYNH

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