36D2268436 CLIA NUMBER - DERMATOLOGY & AESTHETIC CARE

Laboratory Demographics

  • CLIA Code: 36D2268436
  • Facility Name: DERMATOLOGY & AESTHETIC CARE
  • Facility Address: 1299 E ALEX BELL RD
    CENTERVILLE, OH
    ZIP 45459
  • Facility Phone: 937 436-1117
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRADLEY S. SODER
  • NPI Number: 1962795302
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 36D2268436
LAB Type Physician Office
Facility Name DERMATOLOGY & AESTHETIC CARE
Street 1299 E ALEX BELL RD
City CENTERVILLE
State OH
ZIP 45459
Phone 937 436-1117
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Physician Office
Lab Director BRADLEY S. SODER

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