Healthcare Provider Details

I. General information

NPI: 1043267123
Provider Name (Legal Business Name): MELODY ZAMORA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WAGNER AVE
SAN ANTONIO TX
78211-3213
US

IV. Provider business mailing address

3750 COMMERCIAL AVE
SAN ANTONIO TX
78221-3117
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-7344
  • Fax: 210-923-7929
Mailing address:
  • Phone: 210-334-3700
  • Fax: 210-922-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8323
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: