Provider Demographics
NPI:1821330671
Name:ZAMORA, CARMEN AMELIA (DMD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:AMELIA
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 1:12624 MEMORIAL WAY
Mailing Address - Street 2:APT 3139
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7543
Mailing Address - Country:US
Mailing Address - Phone:787-624-6775
Mailing Address - Fax:
Practice Address - Street 1:12624 MEMORIAL WAY
Practice Address - Street 2:APT 3139
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7543
Practice Address - Country:US
Practice Address - Phone:787-624-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0030101223G0001X
CA639961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice