05D2287678 CLIA NUMBER - MAIN STREET DENTAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2287678
  • Facility Name: MAIN STREET DENTAL GROUP
  • Facility Address: 131 W ONTARIO AVE SUITE 102
    CORONA, CA
    ZIP 92882
  • Facility Phone: 951 898-9700
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DEEPIKA DHAMA
  • NPI Number: 1154413912
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 05D2287678
LAB Type Practitioner Other
Facility Name MAIN STREET DENTAL GROUP
Street 131 W ONTARIO AVE SUITE 102
City CORONA
State CA
ZIP 92882
Phone 951 898-9700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type Practitioner Other
Lab Director DEEPIKA DHAMA

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