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04D2079823 CLIA NUMBER - ARKANSAS MEDICAL IMAGING JV, LLC

Laboratory Demographics

CLIA Number: 04D2079823

Facility Name: ARKANSAS MEDICAL IMAGING JV, LLC

Facility Address:
361 E MILLSAP RD
FAYETTEVILLE, AR
ZIP 72703
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Facility Phone Number: 479 442-7740

Facility Type: Other - OUT-PT IMAGING CENTER

Certificate Type: Waiver
NPI Number: 1801237326

Taxonomy: 1223X0400X - Dentist
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.

CLIA Record

Field Name Field Value
CLIA Number 04D2079823
LAB Type Other - OUT-PT IMAGING CENTER
Facility Name ARKANSAS MEDICAL IMAGING JV, LLC
Street 361 E MILLSAP RD
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 442-7740
CertificateType 4
CertificateEffectiveDate 6/25/2022
CertificateExpirationDate 6/24/2024
FacilityType Waiver

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