26D2065905 CLIA NUMBER - MICHAEL SCHOENWALDERDO LLC

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Laboratory Demographics

CLIA Number: 26D2065905

Facility Name: MICHAEL SCHOENWALDERDO LLC

Facility Address:
1585 WOODLAKE DRIVE SUITE 214
CHESTERFIELD, MO
ZIP 63017
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Facility Phone Number: 314 721-2140

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1922671163

Taxonomy: 1223S0112X - Dentist
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

CLIA Record

Field Name	Field Value
CLIA Number	26D2065905
LAB Type	Physician Office
Facility Name	MICHAEL SCHOENWALDERDO LLC
Street	1585 WOODLAKE DRIVE SUITE 214
City	CHESTERFIELD
State	MO
ZIP	63017
Phone	314 721-2140
CertificateType	4
CertificateEffectiveDate	9/17/2023
CertificateExpirationDate	9/16/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024