Provider Demographics
NPI:1053496158
Name:ZAMORA, ANGELIE (DDS PC)
Entity Type:Individual
Prefix:
First Name:ANGELIE
Middle Name:
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 SOUTHGATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7633
Mailing Address - Country:US
Mailing Address - Phone:817-277-1971
Mailing Address - Fax:817-274-3696
Practice Address - Street 1:2216 SOUTHGATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7633
Practice Address - Country:US
Practice Address - Phone:817-277-1971
Practice Address - Fax:817-274-3696
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice