Healthcare Provider Details

I. General information

NPI: 1982543930
Provider Name (Legal Business Name): KELVIN I WAIGANJO DMD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 REVERE BEACH PKWY
EVERETT MA
02149-5912
US

IV. Provider business mailing address

27 PINE TREE DR
METHUEN MA
01844-1268
US

V. Phone/Fax

Practice location:
  • Phone: 617-294-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001428
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: