Provider Demographics
NPI:1366825382
Name:DAVID ZEGARRA D.D.S INC
Entity Type:Organization
Organization Name:DAVID ZEGARRA D.D.S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:ZEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-550-0503
Mailing Address - Street 1:1125 E 17TH ST STE E227
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2218
Mailing Address - Country:US
Mailing Address - Phone:714-550-0503
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST STE E227
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2218
Practice Address - Country:US
Practice Address - Phone:714-550-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty