Provider Demographics
NPI:1922019736
Name:MAESTRELLO, CHRISTOPHER LUCIO (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LUCIO
Last Name:MAESTRELLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-1468
Mailing Address - Country:US
Mailing Address - Phone:804-741-2226
Mailing Address - Fax:
Practice Address - Street 1:2560 GASKINS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-1468
Practice Address - Country:US
Practice Address - Phone:804-741-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010070901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7803311Medicaid