Provider Demographics
NPI:1538531413
Name:ANGELIE ZAMORA DDS PC
Entity type:Organization
Organization Name:ANGELIE ZAMORA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-277-1971
Mailing Address - Street 1:3900 ARLINGTON HIGHLANDS BLVD
Mailing Address - Street 2:# 261
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-6038
Mailing Address - Country:US
Mailing Address - Phone:817-277-1971
Mailing Address - Fax:817-274-3696
Practice Address - Street 1:3900 ARLINGTON HIGHLANDS BLVD
Practice Address - Street 2:# 261
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-6038
Practice Address - Country:US
Practice Address - Phone:817-277-1971
Practice Address - Fax:817-274-3696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELIE V. ZAMORA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-30
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18945332BC3200X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment