Provider Demographics
NPI:1275597106
Name:PRIMM, JOHN PICKARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PICKARD
Last Name:PRIMM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-0176
Mailing Address - Country:US
Mailing Address - Phone:615-797-2298
Mailing Address - Fax:615-797-9958
Practice Address - Street 1:4527 HWY 70 EAST
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187
Practice Address - Country:US
Practice Address - Phone:615-797-2298
Practice Address - Fax:615-797-9958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000002902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0004216OtherBLUE CROSS BLUE SHIELD