Provider Demographics
NPI:1932521481
Name:ZORNOSA, XIMENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:XIMENA
Middle Name:
Last Name:ZORNOSA
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 1:212 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4276
Mailing Address - Country:US
Mailing Address - Phone:678-438-4323
Mailing Address - Fax:
Practice Address - Street 1:428 WINN CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1726
Practice Address - Country:US
Practice Address - Phone:404-296-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0113421223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology