15D2098270 CLIA NUMBER - FOREFRONT DERMATOLOGY, S C

Laboratory Demographics

  • CLIA Code: 15D2098270
  • Facility Name: FOREFRONT DERMATOLOGY, S C
  • Facility Address: 330 N WABASH AVE STE 360
    MARION, IN
    ZIP 46952
  • Facility Phone: 765 664-3292
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROBERT P. DAZE
  • NPI Number: 1285011650
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 15D2098270
LAB Type Physician Office
Facility Name FOREFRONT DERMATOLOGY, S C
Street 330 N WABASH AVE STE 360
City MARION
State IN
ZIP 46952
Phone 765 664-3292
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Physician Office
Lab Director ROBERT P. DAZE

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