35D1040908 CLIA NUMBER - DICKINSON COUNTRY HOUSE LLC

Laboratory Demographics

  • CLIA Code: 35D1040908
  • Facility Name: DICKINSON COUNTRY HOUSE LLC
  • Facility Address: 628 24TH ST W
    DICKINSON, ND
    ZIP 58601
  • Facility Phone: 701 483-2266
  • Facility Type: Other - BASIC CARE FACILITY
  • Facility Type: Waiver
  • Lab Director: STEPHANIE M. HAUGE
  • NPI Number: 1336129113
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 35D1040908
LAB Type Other - BASIC CARE FACILITY
Facility Name DICKINSON COUNTRY HOUSE LLC
Street 628 24TH ST W
City DICKINSON
State ND
ZIP 58601
Phone 701 483-2266
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Other - BASIC CARE FACILITY
Lab Director STEPHANIE M. HAUGE

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