53D2154645 CLIA NUMBER - SYNERGY DENTAL

Laboratory Demographics

  • CLIA Code: 53D2154645
  • Facility Name: SYNERGY DENTAL
  • Facility Address: 501 W LAKEWAY RD
    GILLETTE, WY
    ZIP 82718
  • Facility Phone: 307 682-3100
  • Facility Type: Other - DENTAL OFFICE
  • Facility Type: Waiver
  • Lab Director: DAVID PORTER
  • NPI Number: 1619486784
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 53D2154645
LAB Type Other - DENTAL OFFICE
Facility Name SYNERGY DENTAL
Street 501 W LAKEWAY RD
City GILLETTE
State WY
ZIP 82718
Phone 307 682-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Other - DENTAL OFFICE
Lab Director DAVID PORTER

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This page was last updated on: 9/29/2025