51D2292349 CLIA NUMBER - DR'S KRAJEKIAN, BROCK, HENDERSON, DI PRISCO, & RAVELO, INC

Laboratory Demographics

  • CLIA Code: 51D2292349
  • Facility Name: DR'S KRAJEKIAN, BROCK, HENDERSON, DI PRISCO, & RAVELO, INC
  • Facility Address: 220 LOCUST STREET
    PRINCETON, WV
    ZIP 24740
  • Facility Phone: 304 720-8480
  • Facility Type: Other - ORAL & MAX FACIAL SURG
  • Facility Type: Waiver
  • Lab Director: DR. JAMES M. HENDERSON
  • NPI Number: 1801435003
  • Taxonomy: 1223S0112X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 51D2292349
LAB Type Other - ORAL & MAX FACIAL SURG
Facility Name DR'S KRAJEKIAN, BROCK, HENDERSON, DI PRISCO, & RAVELO, INC
Street 220 LOCUST STREET
City PRINCETON
State WV
ZIP 24740
Phone 304 720-8480
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2023
Certificate Expiration Date 10/23/2025
Facility Type Other - ORAL & MAX FACIAL SURG
Lab Director DR. JAMES M. HENDERSON

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This page was last updated on: 6/4/2025