Healthcare Provider Details

I. General information

NPI: 1881095131
Provider Name (Legal Business Name): ANGELIE V. ZAMORA, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 LONG PRAIRIE RD STE 110
FLOWER MOUND TX
75028-1528
US

IV. Provider business mailing address

3900 ARLINGTON HIGHLANDS BLVD STE 261
ARLINGTON TX
76018-6040
US

V. Phone/Fax

Practice location:
  • Phone: 972-346-1100
  • Fax: 972-355-5411
Mailing address:
  • Phone: 817-277-1971
  • Fax: 817-274-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18945
License Number StateTX

VIII. Authorized Official

Name: DR. ANGELIE VILLARAMA ZAMORA
Title or Position: PRESIDENT
Credential: DDS
Phone: 972-444-9337