Provider Demographics
NPI:1790343861
Name:LWANGA, LILLIAN C (DMD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:C
Last Name:LWANGA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:N BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-1703
Mailing Address - Country:US
Mailing Address - Phone:781-572-0382
Mailing Address - Fax:
Practice Address - Street 1:1888 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2357
Practice Address - Country:US
Practice Address - Phone:860-970-0928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583461223G0001X
390200000X
CT133801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program