Provider Demographics
NPI:1386732089
Name:HERRON, CHRISTOPHER T (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
Last Name:HERRON
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 1:6400 CANOGA AVE
Mailing Address - Street 2:#180
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2425
Mailing Address - Country:US
Mailing Address - Phone:818-887-2880
Mailing Address - Fax:818-887-2644
Practice Address - Street 1:6400 CANOGA AVE
Practice Address - Street 2:#180
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2425
Practice Address - Country:US
Practice Address - Phone:818-887-2880
Practice Address - Fax:818-887-2644
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0330961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice