Active NPI
Albert Anthony Primavera Jr., DMD
- Dentist
- Indian Land, SC
National Provider Identifier
1609353606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11156
- Practice address
- 2021 Bridgemill Dr Ste 100
Indian Land, SC 29707-9211 - Phone
- (803) 848-7100
- NPI assigned
- Jul 23, 2018
- Last updated
- Apr 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11156 | NC | |
| Dentist | 122300000X | 11156 | NC | Primary |
Addresses
Primary practice location
2021 Bridgemill Dr Ste 100
Indian Land, SC 29707-9211
Mailing address
1061 Ansley Park Dr
Indian Land, SC 29707-7885
Phone (239) 273-3981
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11156 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Palmetto Advanced Dentistry | Current | Accepting new patients |
Locations
2021 Bridgemill Dr
Ste 100
Indian Land, SC 29707
Phone (803) 848-7100
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Indian Land, SC
- NPI 1851916332
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650499200000",
"number": "1609353606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1061 ANSLEY PARK DR",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "297077885",
"telephone_number": "239-273-3981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2021 BRIDGEMILL DR STE 100",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "297079211",
"telephone_number": "803-848-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIMAVERA",
"first_name": "ALBERT",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-23",
"last_updated": "2022-04-21",
"certification_date": "2022-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "11156",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "11156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indian Land, SC
- Diane Christine Poehlman, LMHC
- Precision Vision
- Premier Home Healthcare of SC LLC (Boost Home Healthcare - Rock Hill)
- Premier Surgery Center of the Carolinas, LLC
- Karen E Preston, CRNP
- Publix Super Markets Inc (Publix Pharmacy #1412)
- Olivia Kathryn Pyles
- QC Investments, LLC (Indian Land Orthodontics)
- Quantum Medical Group LLC
- Christina Grace Quarterman, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.