MEDICARE: DR. RUSSEL MULAMBA D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33393	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831244474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSEL MULAMBA D.D.S

Provider Business Mailing Address
First Line	:	5122 W PIKE PLAZA RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-3003
Country	:	US
Telephone Number	:	317-293-1595
Fax Number	:	317-293-1352

Provider Business Practice Location Address
First Line	:	2415 S AUSTIN AVE STE 101
Second Line	:
City	:	DENISON
State	:	TX
Zip	:	75020-7742
Country	:	US
Telephone Number	:	903-765-6850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	10/01/2025

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