28D1085526 CLIA NUMBER - DENENBERG FACIAL PLASTIC SURGERY

Laboratory Demographics

CLIA Number: 28D1085526

Facility Name: DENENBERG FACIAL PLASTIC SURGERY

Facility Address:
7640 PACIFIC STREET
OMAHA, NE
ZIP 68114
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Facility Phone Number: 402 391-7640

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1669696878

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	28D1085526
LAB Type	Physician Office
Facility Name	DENENBERG FACIAL PLASTIC SURGERY
Street	7640 PACIFIC STREET
City	OMAHA
State	NE
ZIP	68114
Phone	402 391-7640
CertificateType	4
CertificateEffectiveDate	6/19/2022
CertificateExpirationDate	6/18/2024
FacilityType	Waiver

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