Provider Demographics
NPI:1790350783
Name:PRIMERA DENTAL, LLC
Entity Type:Organization
Organization Name:PRIMERA DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-391-9784
Mailing Address - Street 1:1121 NERGE RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3260
Mailing Address - Country:US
Mailing Address - Phone:773-391-9784
Mailing Address - Fax:
Practice Address - Street 1:1121 NERGE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3260
Practice Address - Country:US
Practice Address - Phone:773-391-9784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental