52D2222289 CLIA NUMBER - WHITEHALL SCHOOL DISTRICT

Laboratory Demographics

CLIA Number: 52D2222289

Facility Name: WHITEHALL SCHOOL DISTRICT

Facility Address:
19121 HOBSON STREET
WHITEHALL, WI
ZIP 54773
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Facility Phone Number: 715 538-4364

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1578215174

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	52D2222289
LAB Type	School/Student Health Service
Facility Name	WHITEHALL SCHOOL DISTRICT
Street	19121 HOBSON STREET
City	WHITEHALL
State	WI
ZIP	54773
Phone	715 538-4364
CertificateType	4
CertificateEffectiveDate	4/28/2023
CertificateExpirationDate	4/27/2025
FacilityType	Waiver

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