Provider Demographics
NPI:1003861865
Name:PRIMLEY, DONALD M (DDS, MS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:PRIMLEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3950 VETERANS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-3410
Mailing Address - Country:US
Mailing Address - Phone:320-252-3611
Mailing Address - Fax:320-252-7574
Practice Address - Street 1:3950 VETERANS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3410
Practice Address - Country:US
Practice Address - Phone:320-252-3611
Practice Address - Fax:320-252-7574
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND105521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU18806Medicare UPIN