=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740472729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAG ZAPATERO,DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2007
-----------------------------------------------------
Last Update Date | 08/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3020 SHORE DR SUITE A
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23451-1295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-481-3893
-----------------------------------------------------
Fax | 757-481-0425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3020 SHORE DR SUITE A
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23451-1295
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-481-3893
-----------------------------------------------------
Fax | 757-481-0425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. DAGOBERTO GONZALOS ZAPATERO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 757-481-3893
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401007450
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------