Provider Demographics
NPI:1972606523
Name:PRIMUS, MELISSA D (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:PRIMUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 LIGHTNER WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-631-9863
Mailing Address - Fax:661-663-8345
Practice Address - Street 1:5509 YOUNG ST
Practice Address - Street 2:CAL DEPT CORRECTIONS & REHAB DCHCS REGIONIII DENTAL
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9648
Practice Address - Country:US
Practice Address - Phone:916-708-6306
Practice Address - Fax:661-664-2563
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice