Individual
DR. JASON C PRIMAVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(801) 358-8697
Mailing address
6050 BRYNWOOD DR, ROCKFORD, IL 61114-6579
(815) 877-0694
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
018001817
IL
Other
Enumeration date
07/19/2011
Last updated
08/24/2015
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