Provider Demographics
NPI:1104908565
Name:PATRICIA PRIMERO D.D.S., P.A.
Entity type:Organization
Organization Name:PATRICIA PRIMERO D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:239-254-4480
Mailing Address - Street 1:9010 STRADA STELL CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4424
Mailing Address - Country:US
Mailing Address - Phone:239-254-4480
Mailing Address - Fax:239-254-8575
Practice Address - Street 1:9010 STRADA STELL CT
Practice Address - Street 2:SUITE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4424
Practice Address - Country:US
Practice Address - Phone:239-254-4480
Practice Address - Fax:239-254-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12193305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER