14D2175214 CLIA NUMBER - BRANDON J HISSONG, D M D

Laboratory Demographics

  • CLIA Code: 14D2175214
  • Facility Name: BRANDON J HISSONG, D M D
  • Facility Address: 806 W BRIDGE ST
    MONTICELLO, IL
    ZIP 61856
  • Facility Phone: 217 762-7175
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BRANDON J. HISSONG
  • NPI Number: 1952325417
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 14D2175214
LAB Type Practitioner Other
Facility Name BRANDON J HISSONG, D M D
Street 806 W BRIDGE ST
City MONTICELLO
State IL
ZIP 61856
Phone 217 762-7175
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Practitioner Other
Lab Director BRANDON J. HISSONG

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This page was last updated on: 3/20/2025