45D2233097 CLIA NUMBER - REVIVAL DERMATOLOGY PLLC

Laboratory Demographics

  • CLIA Code: 45D2233097
  • Facility Name: REVIVAL DERMATOLOGY PLLC
  • Facility Address: 8201 PRESTON RD STE 440
    DALLAS, TX
    ZIP 75225
  • Facility Phone: (216) 675-3227
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LISA GUIDRY PRUETT
  • NPI Number: 1679149702
  • Taxonomy: 207N00000X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 45D2233097
LAB Type Physician Office
Facility Name REVIVAL DERMATOLOGY PLLC
Street 8201 PRESTON RD STE 440
City DALLAS
State TX
ZIP 75225
Phone 2166753227
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/19/2025
Certificate Expiration Date 8/18/2027
Facility Type Physician Office
Lab Director LISA GUIDRY PRUETT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 5/18/2026