Provider Demographics
NPI:1811442635
Name:E. C. PRIMMER, D.D.S.
Entity type:Organization
Organization Name:E. C. PRIMMER, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRIMMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-395-7044
Mailing Address - Street 1:4225 GLASS RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2564
Mailing Address - Country:US
Mailing Address - Phone:319-395-7044
Mailing Address - Fax:319-395-0232
Practice Address - Street 1:4225 GLASS RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2564
Practice Address - Country:US
Practice Address - Phone:319-395-7044
Practice Address - Fax:319-395-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty