Serena Autumn Waterworth-West, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12035 Issued in OR

Practice address

387 NE 223Rd Ave
Gresham, OR 97030-8554

Phone

(503) 491-5450

NPI assigned

Jul 12, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• WA PPO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gresham Modern Dentistry, PC

  • Dentist
  • Gresham, OR
  • NPI 1760728786
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778544000000",
    "number": "1043057334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1268 NE 186TH DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972307127",
            "telephone_number": "503-530-0609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 NE 223RD AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970308554",
            "telephone_number": "503-491-5450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERWORTH-WEST",
        "first_name": "SERENA",
        "middle_name": "AUTUMN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-12",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D12035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole E Warren, MA
• Whitney Hope Warth, DMD
• Jessica L Washington
• Jaime Wasik, RN, MSN, FNP
• Makiah Ceartas Waters, LCSW
• Angela Michelle Watson, CADC APPLICANT
• Stephanie Jean Weaver
• James M Webb, DO
• Leann Webb
• Tina Webb

• General Practice Dentistry in Gresham, OR
• Providers in Gresham, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.