Healthcare Provider Details

I. General information

NPI: 1477751758
Provider Name (Legal Business Name): GUILLERMO ZAPATA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GLENBROOK RD APT. 534
STAMFORD CT
06902-2871
US

IV. Provider business mailing address

25 GLENBROOK RD APT. 534
STAMFORD CT
06902-2871
US

V. Phone/Fax

Practice location:
  • Phone: 860-881-0884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number11048
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: