Provider Demographics
NPI:1225533102
Name:HERRERA, CHRISTIAN EDUARDO
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:EDUARDO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 GREY OAKS PARK LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5771
Mailing Address - Country:US
Mailing Address - Phone:704-247-0829
Mailing Address - Fax:
Practice Address - Street 1:2026 GREY OAKS PARK LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5771
Practice Address - Country:US
Practice Address - Phone:704-247-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014155211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics