42D1051439 CLIA NUMBER - CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA

Laboratory Demographics

CLIA Number: 42D1051439

Facility Name: CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA

Facility Address:
502 W MEETING ST
LANCASTER, SC
ZIP 29720
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Facility Phone Number: 803 285-9492

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1164448247

Taxonomy: 208800000X - Urology
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

CLIA Record

Field Name	Field Value
CLIA Number	42D1051439
LAB Type	Other
Facility Name	CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA
Street	502 W MEETING ST
City	LANCASTER
State	SC
ZIP	29720
Phone	803 285-9492
CertificateType	4
CertificateEffectiveDate	3/2/2024
CertificateExpirationDate	3/1/2026
FacilityType	Waiver

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