Provider Demographics
NPI:1043267123
Name:ZAMORA, MELODY (DMD)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3700
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:910 WAGNER AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3213
Practice Address - Country:US
Practice Address - Phone:210-924-7344
Practice Address - Fax:210-923-7929
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23690OtherLICENSE
TX23690OtherLICENSE