Provider Demographics
NPI:1538360235
Name:GESICHO, GLADYS KWAMBOKA (DDS)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:KWAMBOKA
Last Name:GESICHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E HAWKEYE AVE
Mailing Address - Street 2:STE # 2
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-7505
Mailing Address - Country:US
Mailing Address - Phone:209-632-2082
Mailing Address - Fax:209-632-2357
Practice Address - Street 1:711 E HAWKEYE AVE
Practice Address - Street 2:STE # 2
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-7505
Practice Address - Country:US
Practice Address - Phone:209-632-2082
Practice Address - Fax:209-632-2357
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice