37D2222268 CLIA NUMBER - OKEMAH INDIAN DENTAL CLINIC

Laboratory Demographics

CLIA Number: 37D2222268

Facility Name: OKEMAH INDIAN DENTAL CLINIC

Facility Address:
1509 W COLUMBIA ST
OKEMAH, OK
ZIP 74859
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Facility Phone Number: 918 623-3016

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1821276445

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	37D2222268
LAB Type	Practitioner Other
Facility Name	OKEMAH INDIAN DENTAL CLINIC
Street	1509 W COLUMBIA ST
City	OKEMAH
State	OK
ZIP	74859
Phone	918 623-3016
CertificateType	4
CertificateEffectiveDate	4/28/2023
CertificateExpirationDate	4/27/2025
FacilityType	Waiver

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