Healthcare Provider Details

I. General information

NPI: 1881522928
Provider Name (Legal Business Name): DR. HAM SEMAYENGO KIBUUKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 COURT ST
MIDDLEBURY VT
05753-1470
US

IV. Provider business mailing address

3727 CASTLE TER
SILVER SPRING MD
20904-4769
US

V. Phone/Fax

Practice location:
  • Phone: 802-499-2342
  • Fax:
Mailing address:
  • Phone: 909-674-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016.0134450
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: