Individual
KRISTA S PRIMLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2581 DEVELOPMENT DR, GREEN BAY, WI 54311-4247
(920) 347-0400
(920) 347-0868
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6001396
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D14292
MN
390200000X
Student in an Organized Health Care Education/Training Program
RES-30533
IA
Other
Enumeration date
02/16/2018
Last updated
02/06/2024
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