Provider Demographics
NPI:1134746746
Name:MWANYANGE, GILBERT MWACHIA (DMD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:MWACHIA
Last Name:MWANYANGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 W AVENUE K6
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1724
Mailing Address - Country:US
Mailing Address - Phone:262-237-9760
Mailing Address - Fax:
Practice Address - Street 1:1002 N LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1154
Practice Address - Country:US
Practice Address - Phone:936-760-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice