Healthcare Provider Details

I. General information

NPI: 1871690990
Provider Name (Legal Business Name): DAG ZAPATERO DDS MAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAGOBERTO GONZALOS ZAPATERO DDS

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 SHORE DRIVE SUITE A
VIRGINIA BEACH VA
23451
US

IV. Provider business mailing address

3020 SHORE DR SUITE A
VIRGINIA BEACH VA
23451-1295
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-8893
  • Fax: 757-481-0425
Mailing address:
  • Phone: 757-481-8893
  • Fax: 757-481-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401007450
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: