Provider Demographics
NPI:1619380110
Name:DANIELA ZAMBON DDS MS PC
Entity Type:Organization
Organization Name:DANIELA ZAMBON DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMBON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:817-453-7766
Mailing Address - Street 1:1757 BROAD PARK CIR N
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7825
Mailing Address - Country:US
Mailing Address - Phone:817-453-7766
Mailing Address - Fax:817-887-5625
Practice Address - Street 1:1757 BROAD PARK CIR N
Practice Address - Street 2:SUITE 301
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7825
Practice Address - Country:US
Practice Address - Phone:817-453-7766
Practice Address - Fax:817-887-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty