Provider Demographics
NPI:1124440110
Name:PRIMAC, DAVID JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:PRIMAC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:239 S LA CIENEGA BLVD
Mailing Address - Street 2:#208
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3328
Mailing Address - Country:US
Mailing Address - Phone:310-652-1318
Mailing Address - Fax:310-652-3028
Practice Address - Street 1:239 S LA CIENEGA BLVD
Practice Address - Street 2:#208
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3328
Practice Address - Country:US
Practice Address - Phone:310-652-1318
Practice Address - Fax:310-652-3028
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADW031359125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist