42D2170862 CLIA NUMBER - FIVE FORKS DENTAL CARE, INC

Laboratory Demographics

  • CLIA Code: 42D2170862
  • Facility Name: FIVE FORKS DENTAL CARE, INC
  • Facility Address: 2833 WOODRUFF RD
    SIMPSONVILLE, SC
    ZIP 29681
  • Facility Phone: 864 289-0289
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KRISTINA L. HAPNEY
  • NPI Number: 1609343227
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 42D2170862
LAB Type Practitioner Other
Facility Name FIVE FORKS DENTAL CARE, INC
Street 2833 WOODRUFF RD
City SIMPSONVILLE
State SC
ZIP 29681
Phone 864 289-0289
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2025
Certificate Expiration Date 8/20/2027
Facility Type Practitioner Other
Lab Director KRISTINA L. HAPNEY

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