Provider Demographics
NPI:1346470663
Name:CENTENNIAL LABORATORY, LLC
Entity Type:Organization
Organization Name:CENTENNIAL LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:DABLAH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-822-6845
Mailing Address - Street 1:3525 W FREDDY GONZALEZ DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8544
Mailing Address - Country:US
Mailing Address - Phone:956-381-0440
Mailing Address - Fax:956-381-0483
Practice Address - Street 1:3525 W FREDDY GONZALEZ DR
Practice Address - Street 2:SUITE B
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8544
Practice Address - Country:US
Practice Address - Phone:956-381-0440
Practice Address - Fax:956-381-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory