23D2160552 CLIA NUMBER - SUMMIT ORAL AND MAXILLOFACIAL SURGERY

Laboratory Demographics

  • CLIA Code: 23D2160552
  • Facility Name: SUMMIT ORAL AND MAXILLOFACIAL SURGERY
  • Facility Address: 12150 30 MILE ROAD SUITE 202
    WASHINGTON TOWNSHIP, MI
    ZIP 48095
  • Facility Phone: 586 755-9340
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: GREGORY J. THOMAS
  • NPI Number: 1811066129
  • Taxonomy: 1223S0112X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 23D2160552
LAB Type Practitioner Other
Facility Name SUMMIT ORAL AND MAXILLOFACIAL SURGERY
Street 12150 30 MILE ROAD SUITE 202
City WASHINGTON TOWNSHIP
State MI
ZIP 48095
Phone 586 755-9340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2025
Certificate Expiration Date 1/13/2027
Facility Type Practitioner Other
Lab Director GREGORY J. THOMAS

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