49D1101814 CLIA NUMBER - LLOYD F MOSS FREE CLINIC

Laboratory Demographics

CLIA Number: 49D1101814

Facility Name: LLOYD F MOSS FREE CLINIC

Facility Address:
1301 SAM PERRY BOULEVARD - SUITE 100
FREDERICKSBURG, VA
ZIP 22401
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Facility Phone Number: 540 741-1065

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1720298128

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	49D1101814
LAB Type	Community Clinic
Facility Name	LLOYD F MOSS FREE CLINIC
Street	1301 SAM PERRY BOULEVARD - SUITE 100
City	FREDERICKSBURG
State	VA
ZIP	22401
Phone	540 741-1065
CertificateType	4
CertificateEffectiveDate	7/6/2023
CertificateExpirationDate	7/5/2025
FacilityType	Waiver

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