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: 03/26/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ESSEX ST UNIT 1A1
LAWRENCE MA
01841-4396
US

IV. Provider business mailing address

20000 N 57TH AVE RM M210
GLENDALE AZ
85308-6996
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: