Healthcare Provider Details

I. General information

NPI: 1104908565
Provider Name (Legal Business Name): PATRICIA PRIMERO D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 STRADA STELL CT SUITE 101
NAPLES FL
34109-4424
US

IV. Provider business mailing address

9010 STRADA STELL CT SUITE 101
NAPLES FL
34109-4424
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-4480
  • Fax: 239-254-8575
Mailing address:
  • Phone: 239-254-4480
  • Fax: 239-254-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberDN 12193
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICIA PRIMERO
Title or Position: PRESIDENT
Credential: D.D.S., P.A.
Phone: 239-254-4480