Provider Demographics
NPI:1710722905
Name:ZARATE, SIERRA (DMD)
Entity type:Individual
Prefix:DR
First Name:SIERRA
Middle Name:
Last Name:ZARATE
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 1:4318 CARROLLWOOD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8657
Mailing Address - Country:US
Mailing Address - Phone:813-417-2471
Mailing Address - Fax:
Practice Address - Street 1:4156 WOODLANDS PKWY STE A
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3478
Practice Address - Country:US
Practice Address - Phone:727-205-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL263011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty