15D2215827 CLIA NUMBER - PREMIER DENTAL CARE

Laboratory Demographics

  • CLIA Code: 15D2215827
  • Facility Name: PREMIER DENTAL CARE
  • Facility Address: 6920 S EAST ST SUITE A
    INDIANAPOLIS, IN
    ZIP 46227
  • Facility Phone: 317 787-6625
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARLA K. WILSON
  • NPI Number: 1770787657
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 15D2215827
LAB Type Physician Office
Facility Name PREMIER DENTAL CARE
Street 6920 S EAST ST SUITE A
City INDIANAPOLIS
State IN
ZIP 46227
Phone 317 787-6625
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2025
Certificate Expiration Date 3/7/2027
Facility Type Physician Office
Lab Director MARLA K. WILSON

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