50D2160483 CLIA NUMBER - MAPLE STREET CLINIC

Laboratory Demographics

CLIA Number: 50D2160483

Facility Name: MAPLE STREET CLINIC

Facility Address:
3919 N MAPLE ST
SPOKANE, WA
ZIP 99205
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Facility Phone Number: 509 444-8200

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1235509639

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	50D2160483
LAB Type	Federally Qualified Health Center
Facility Name	MAPLE STREET CLINIC
Street	3919 N MAPLE ST
City	SPOKANE
State	WA
ZIP	99205
Phone	509 444-8200
CertificateType	3
CertificateEffectiveDate	1/11/2019
CertificateExpirationDate	4/4/2028
FacilityType	PPMP

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