Active NPI
Ken Wayne Waddell, D.M.D.
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1134239155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D5796
- Practice address
- 15495 SW Sequoia Pkwy
Suite 120
Portland, OR 97224-6100 - Phone
- (503) 684-8445
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D5796 | OR | Primary |
Addresses
Primary practice location
15495 SW Sequoia Pkwy
Suite 120
Portland, OR 97224-6100
Mailing address
15495 SW Sequoia Pkwy
Suite 120
Portland, OR 97224-6100
Phone (503) 684-8445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D5796 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ken W. Waddell, DMD P.C. | General Practice | Past | Accepting new patients |
| TJ Houlihan DMD LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Dental Professional
- General Practice Dentistry
- Portland, OR
- NPI 1356530422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1134239155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15495 SW SEQUOIA PKWY",
"address_2": "SUITE 120",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972246100",
"telephone_number": "503-684-8445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15495 SW SEQUOIA PKWY",
"address_2": "SUITE 120",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972246100",
"telephone_number": "503-684-8445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADDELL",
"first_name": "KEN",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D5796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.