MEDICARE: PATRICIA PRIMERO D.D.S., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	DN 12193	FL

General Provider Information

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

Provider Business Mailing Address
First Line	:	9010 STRADA STELL CT
Second Line	:	SUITE 101
City	:	NAPLES
State	:	FL
Zip	:	34109-4424
Country	:	US
Telephone Number	:	239-254-4480
Fax Number	:	239-254-8575

Provider Business Practice Location Address
First Line	:	9010 STRADA STELL CT
Second Line	:	SUITE 101
City	:	NAPLES
State	:	FL
Zip	:	34109-4424
Country	:	US
Telephone Number	:	239-254-4480
Fax Number	:	239-254-8575

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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