Provider Demographics
NPI:1003638750
Name:ZAPATA HENAO, CARLOS (DMD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ZAPATA HENAO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 LODI TER APT 5209
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7449
Mailing Address - Country:US
Mailing Address - Phone:954-249-0274
Mailing Address - Fax:
Practice Address - Street 1:1993 DANIELS RD STE 120
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4598
Practice Address - Country:US
Practice Address - Phone:407-863-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29356122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist