10D2295385 CLIA NUMBER - PEDIATRICS AND FAMILY CARE LLC

Laboratory Demographics

CLIA Number: 10D2295385

Facility Name: PEDIATRICS AND FAMILY CARE LLC

Facility Address:
167 LOOKOUT PL
MAITLAND, FL
ZIP 32751
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Facility Phone Number: 407 792-0319

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1770266926

Taxonomy: 1223P0221X - Dentist
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

CLIA Record

Field Name	Field Value
CLIA Number	10D2295385
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	PEDIATRICS AND FAMILY CARE LLC
Street	167 LOOKOUT PL
City	MAITLAND
State	FL
ZIP	32751
Phone	407 792-0319
CertificateType	4
CertificateEffectiveDate	12/11/2023
CertificateExpirationDate	12/10/2025
FacilityType	Waiver

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