45D2169669 CLIA NUMBER - FOREST LANE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 45D2169669
  • Facility Name: FOREST LANE PEDIATRICS
  • Facility Address: 7777 FOREST LN BLDG B SUITE 308
    DALLAS, TX
    ZIP 75230
  • Facility Phone: 972 284-7770
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RONALD M. BLAIR
  • NPI Number: 1629255930
  • Taxonomy: 2471M1202X - Radiologic Technologist

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CLIA Record

Field Name Field Value
CLIA Number 45D2169669
LAB Type Physician Office
Facility Name FOREST LANE PEDIATRICS
Street 7777 FOREST LN BLDG B SUITE 308
City DALLAS
State TX
ZIP 75230
Phone 972 284-7770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2025
Certificate Expiration Date 7/23/2027
Facility Type Physician Office
Lab Director RONALD M. BLAIR

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