26D2190789 CLIA NUMBER - CHILDREN'S DENTAL ZONE

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Laboratory Demographics

CLIA Number: 26D2190789

Facility Name: CHILDREN'S DENTAL ZONE

Facility Address:
13410 NEW HALLS FERRY ROAD
FLORISSANT, MO
ZIP 63033
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Facility Phone Number: 314 830-9663

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700172806

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D2190789
LAB Type	Physician Office
Facility Name	CHILDREN'S DENTAL ZONE
Street	13410 NEW HALLS FERRY ROAD
City	FLORISSANT
State	MO
ZIP	63033
Phone	314 830-9663
CertificateType	4
CertificateEffectiveDate	8/19/2022
CertificateExpirationDate	8/18/2024
FacilityType	Waiver

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