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General NPI Number Information
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NPI Number | 1952894354
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Entity Type | Individual
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Provider Name | LORENA CASTRO CAMPOS HERRERA DDS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 16631 COIT RD STE 114
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City | DALLAS
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State | TX
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Zip | 75248-1795
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Country | US
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Telephone | 214-484-5978
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 BENT BOW DR
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City | GARLAND
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State | TX
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Zip | 75044-6016
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Country | US
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Telephone | 469-422-2260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 34168
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License Number State | TX
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