Healthcare Provider Details

I. General information

NPI: 1538531413
Provider Name (Legal Business Name): ANGELIE ZAMORA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 ARLINGTON HIGHLANDS BLVD # 261
ARLINGTON TX
76018-6038
US

IV. Provider business mailing address

3900 ARLINGTON HIGHLANDS BLVD # 261
ARLINGTON TX
76018-6038
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-1971
  • Fax: 817-274-3696
Mailing address:
  • Phone: 817-277-1971
  • Fax: 817-274-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number18945
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELIE V. ZAMORA
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 817-277-1971