Provider Demographics
NPI:1881095131
Name:ANGELIE V. ZAMORA, DDS
Entity type:Organization
Organization Name:ANGELIE V. ZAMORA, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELIE
Authorized Official - Middle Name:VILLARAMA
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-444-9337
Mailing Address - Street 1:3900 ARLINGTON HIGHLANDS BLVD STE 261
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-6040
Mailing Address - Country:US
Mailing Address - Phone:817-277-1971
Mailing Address - Fax:817-274-3696
Practice Address - Street 1:4001 LONG PRAIRIE RD STE 110
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1528
Practice Address - Country:US
Practice Address - Phone:972-346-1100
Practice Address - Fax:972-355-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334292501Medicaid