Healthcare Provider Details

I. General information

NPI: 1922019736
Provider Name (Legal Business Name): CHRISTOPHER LUCIO MAESTRELLO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 GASKINS RD
RICHMOND VA
23238-1468
US

IV. Provider business mailing address

2560 GASKINS RD
RICHMOND VA
23238-1468
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-2226
  • Fax:
Mailing address:
  • Phone: 804-741-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401007090
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: