14D2171607 CLIA NUMBER - ORAL & MAXILLOFACIAL SURGERY OF CARBONDALE

Laboratory Demographics

  • CLIA Code: 14D2171607
  • Facility Name: ORAL & MAXILLOFACIAL SURGERY OF CARBONDALE
  • Facility Address: 1111 E WALNUT ST - STE B
    CARBONDALE, IL
    ZIP 62901
  • Facility Phone: 618 529-2572
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BILLY B. LAUN I I
  • NPI Number: 1194381640
  • Taxonomy: 1223S0112X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 14D2171607
LAB Type Practitioner Other
Facility Name ORAL & MAXILLOFACIAL SURGERY OF CARBONDALE
Street 1111 E WALNUT ST - STE B
City CARBONDALE
State IL
ZIP 62901
Phone 618 529-2572
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Practitioner Other
Lab Director BILLY B. LAUN I I

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