Provider Demographics
NPI:1629092648
Name:PRIMA, HENNO ALLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENNO
Middle Name:ALLAN
Last Name:PRIMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 ROUTE 88
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3227
Mailing Address - Country:US
Mailing Address - Phone:732-899-8181
Mailing Address - Fax:
Practice Address - Street 1:2141 ROUTE 88
Practice Address - Street 2:SUITE 2
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3227
Practice Address - Country:US
Practice Address - Phone:732-899-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0160941223G0001X
CO85391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice