Provider Demographics
NPI:1619106606
Name:ZORA, DIAA (DDS)
Entity Type:Individual
Prefix:
First Name:DIAA
Middle Name:
Last Name:ZORA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5615
Mailing Address - Country:US
Mailing Address - Phone:936-291-9021
Mailing Address - Fax:936-291-2149
Practice Address - Street 1:1333 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5615
Practice Address - Country:US
Practice Address - Phone:936-291-9021
Practice Address - Fax:936-291-2149
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58392122300000X
TX25277122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2108557Medicaid