Healthcare Provider Details

I. General information

NPI: 1003638750
Provider Name (Legal Business Name): CARLOS ZAPATA HENAO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 DANIELS RD STE 120
WINTER GARDEN FL
34787-4598
US

IV. Provider business mailing address

13512 LODI TER APT 5209
WINDERMERE FL
34786-7449
US

V. Phone/Fax

Practice location:
  • Phone: 407-863-0476
  • Fax:
Mailing address:
  • Phone: 954-249-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number29356
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: