26D2137169 CLIA NUMBER - PREMIER DENTAL ANESTHESIOLOGY

Laboratory Demographics

CLIA Number: 26D2137169

Facility Name: PREMIER DENTAL ANESTHESIOLOGY

Facility Address:
359 CONSORT DRIVE
BALLWIN, MO
ZIP 63011
Get Directions

Facility Phone Number: 636 386-1120

Facility Type: Other - MOBILE ANESTHESIA

Certificate Type: Waiver

NPI Number: 1366585911

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	26D2137169
LAB Type	Other - MOBILE ANESTHESIA
Facility Name	PREMIER DENTAL ANESTHESIOLOGY
Street	359 CONSORT DRIVE
City	BALLWIN
State	MO
ZIP	63011
Phone	636 386-1120
CertificateType	4
CertificateEffectiveDate	9/21/2023
CertificateExpirationDate	9/20/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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