35D1058032 CLIA NUMBER - FACE AND JAW SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 35D1058032
  • Facility Name: FACE AND JAW SURGERY CENTER
  • Facility Address: 1730 BURNT BOAT DR SUITE 300
    BISMARCK, ND
    ZIP 58503
  • Facility Phone: 701 258-7220
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: JOSEPH R. DEATHERAGE
  • NPI Number: 1396343737
  • Taxonomy: 1223S0112X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 35D1058032
LAB Type Other
Facility Name FACE AND JAW SURGERY CENTER
Street 1730 BURNT BOAT DR SUITE 300
City BISMARCK
State ND
ZIP 58503
Phone 701 258-7220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Other
Lab Director JOSEPH R. DEATHERAGE

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