Basic Information
| Provider Information | |||||||||
| NPI: | 1780159764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRERO | ||||||||
| FirstName: | KRYSTEN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 HUGUENOT RD | ||||||||
| Address2: | |||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047949789 | ||||||||
| FaxNumber: | 8044191059 | ||||||||
| Practice Location | |||||||||
| Address1: | 7291 MARKET PLACE DR | ||||||||
| Address2: | |||||||||
| City: | QUINTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049324537 | ||||||||
| FaxNumber: | 8044191059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2018 | ||||||||
| LastUpdateDate: | 08/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 0401416318 | VA | Y | Dental Providers | Dentist |
No ID Information.