Individual
DR. ALBERT ANTHONY PRIMAVERA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2021 BRIDGEMILL DR STE 100, INDIAN LAND, SC 29707-9211
(803) 848-7100
Mailing address
1061 ANSLEY PARK DR, INDIAN LAND, SC 29707-7885
(239) 273-3981
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11156
NC
1223G0001X
General Practice Dentistry
11156
NC
Other
Enumeration date
07/23/2018
Last updated
04/21/2022
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