Individual
CARL E PRIMAVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1588 SOQUEL DR, SANTA CRUZ, CA 95065-1714
(831) 476-4020
Mailing address
1588 SOQUEL DR, SANTA CRUZ, CA 95065-1714
(831) 476-4020
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
21050
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21629043
EDD ACCOUNT NUMBER
CA
Enumeration date
05/31/2007
Last updated
07/08/2007
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