31D2209039 CLIA NUMBER - PRECIDENT OF NEW JERSEY, LLC

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Laboratory Demographics

CLIA Number: 31D2209039

Facility Name: PRECIDENT OF NEW JERSEY, LLC

Facility Address:
1135 BROAD ST SUITE 100
CLIFTON, NJ
ZIP 07013
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Facility Phone Number: 973 256-0103

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164806972

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	31D2209039
LAB Type	Physician Office
Facility Name	PRECIDENT OF NEW JERSEY, LLC
Street	1135 BROAD ST SUITE 100
City	CLIFTON
State	NJ
ZIP	07013
Phone	973 256-0103
CertificateType	4
CertificateEffectiveDate	1/11/2023
CertificateExpirationDate	1/10/2025
FacilityType	Waiver

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