29D2264144 CLIA NUMBER - LAS VEGAS MODERN DENTISTRY AND ORTHODONTICS

Laboratory Demographics

  • CLIA Code: 29D2264144
  • Facility Name: LAS VEGAS MODERN DENTISTRY AND ORTHODONTICS
  • Facility Address: 7171 W CRAIG ROAD, SUITE 102
    LAS VEGAS, NV
    ZIP 89129
  • Facility Phone: 702 665-0331
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BRIAN FREEMAN
  • NPI Number: 1972714970
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 29D2264144
LAB Type Practitioner Other
Facility Name LAS VEGAS MODERN DENTISTRY AND ORTHODONTICS
Street 7171 W CRAIG ROAD, SUITE 102
City LAS VEGAS
State NV
ZIP 89129
Phone 702 665-0331
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2024
Certificate Expiration Date 7/10/2026
Facility Type Practitioner Other
Lab Director BRIAN FREEMAN

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