Provider Demographics
NPI:1144876731
Name:DAVID R. PRIMROSE, DDS PLLC
Entity type:Organization
Organization Name:DAVID R. PRIMROSE, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PRIMROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-250-5891
Mailing Address - Street 1:883 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-5011
Mailing Address - Country:US
Mailing Address - Phone:206-250-5891
Mailing Address - Fax:
Practice Address - Street 1:38700 SE RIVER ST
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5154
Practice Address - Country:US
Practice Address - Phone:425-888-2703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty