Provider Demographics
NPI:1952894354
Name:HERRERA, LORENA CASTRO CAMPOS (DDS)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:CASTRO CAMPOS
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 BENT BOW DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6016
Mailing Address - Country:US
Mailing Address - Phone:469-422-2260
Mailing Address - Fax:
Practice Address - Street 1:16631 COIT RD STE 114
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1795
Practice Address - Country:US
Practice Address - Phone:214-484-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice