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NPI Code Detail

MEDICARE: DR. HENNO ALLAN PRIMA D.M.D.

MEDICARE: DR. HENNO ALLAN PRIMA D.M.D.
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
11223G0001XGeneral Practice DentistryDI016094NJ
21223G0001XGeneral Practice Dentistry8539CO

General Provider Information

NPI Number : 1629092648
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HENNO ALLAN PRIMA D.M.D.
Provider Business Mailing Address
First Line : 2141 ROUTE 88
Second Line : SUITE 2
City : BRICK
State : NJ
Zip : 08724-3227
Country : US
Telephone Number : 732-899-8181
Fax Number :
Provider Business Practice Location Address
First Line : 2141 ROUTE 88
Second Line : SUITE 2
City : BRICK
State : NJ
Zip : 08724-3227
Country : US
Telephone Number : 732-899-8181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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