04D2192879 CLIA NUMBER - MOBILECARE DENTAL, PLLC

Laboratory Demographics

  • CLIA Code: 04D2192879
  • Facility Name: MOBILECARE DENTAL, PLLC
  • Facility Address: 105 N 28TH ST
    VAN BUREN, AR
    ZIP 72956
  • Facility Phone: 479 471-1677
  • Facility Type: Other - ANCILLARY FOR LTC/AL DENT
  • Facility Type: Waiver
  • Lab Director: DR. PHILIP S. MORTON
  • NPI Number: 1104369370
  • Taxonomy: 261QD0000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2192879
LAB Type Other - ANCILLARY FOR LTC/AL DENT
Facility Name MOBILECARE DENTAL, PLLC
Street 105 N 28TH ST
City VAN BUREN
State AR
ZIP 72956
Phone 479 471-1677
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/15/2024
Certificate Expiration Date 9/14/2026
Facility Type Other - ANCILLARY FOR LTC/AL DENT
Lab Director DR. PHILIP S. MORTON

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