14D2004458 CLIA NUMBER - OFFICE ANESTHESIOLOGY & DENTAL CONSULTANTS PC

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Laboratory Demographics

CLIA Number: 14D2004458

Facility Name: OFFICE ANESTHESIOLOGY & DENTAL CONSULTANTS PC

Facility Address:
1S161 SUMMIT AVE
OAKBROOK TERRACE, IL
ZIP 60181
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Facility Phone Number: 630 620-9199

Facility Type: Other - OFFICE-BASED ANESTHESIOLO

Certificate Type: Waiver

NPI Number: 1649575630

Taxonomy: 1223D0004X - Dentist
A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation's Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology.

CLIA Record

Field Name	Field Value
CLIA Number	14D2004458
LAB Type	Other - OFFICE-BASED ANESTHESIOLO
Facility Name	OFFICE ANESTHESIOLOGY & DENTAL CONSULTANTS PC
Street	1S161 SUMMIT AVE
City	OAKBROOK TERRACE
State	IL
ZIP	60181
Phone	630 620-9199
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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