Provider Demographics
NPI:1821291634
Name:PRIMM, JASON TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TODD
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 1:213 OVERLOOK CIRCLE
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-370-9486
Mailing Address - Fax:615-370-8681
Practice Address - Street 1:213 OVERLOOK CIRCLE
Practice Address - Street 2:SUITE B-4
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-370-9486
Practice Address - Fax:615-370-8681
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85441223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice