10D2209554 CLIA NUMBER - MICHAEL STINE DO LLC

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Laboratory Demographics

CLIA Number: 10D2209554

Facility Name: MICHAEL STINE DO LLC

Facility Address:
1122 BELL SHOALS ROAD SUITE 101
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 553-7700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518507227

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	10D2209554
LAB Type	Physician Office
Facility Name	MICHAEL STINE DO LLC
Street	1122 BELL SHOALS ROAD SUITE 101
City	BRANDON
State	FL
ZIP	33511
Phone	813 553-7700
CertificateType	4
CertificateEffectiveDate	1/14/2023
CertificateExpirationDate	1/13/2025
FacilityType	Waiver

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