Marco Oktoviator Waworuntu

Primary specialty

DentistTaxonomy code 122300000X

License

61565869 Issued in WA

Practice address

5003 Tacoma Mall Blvd Ste 103
Tacoma, WA 98409-7120

Phone

(253) 881-8780

NPI assigned

Mar 8, 2023

Last updated

Aug 14, 2024By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Han Dental Group PLLC

  dba South Hill Family Dentistry

  • Dentist
  • Puyallup, WA
  • NPI 1679905368
  NPD (past)

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

{
    "created_epoch": "1678233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1235839259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5003 TACOMA MALL BLVD",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5003 TACOMA MALL BLVD STE 103",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097120",
            "telephone_number": "253-881-8780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11201 88th Ave E Ste 110",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983733802",
            "country_code": "US",
            "telephone_number": "253-848-2988",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18710 Meridian E Ste 216",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983752231",
            "country_code": "US",
            "telephone_number": "253-321-1198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAWORUNTU",
        "first_name": "MARCO",
        "middle_name": "OKTOVIATOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-08",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "61565869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Watterson, PA-C
• Watts & Pla DMD MSD PLLC (Pla & Watts Endodontics)
• Donna K Watts, MSPA CCCA FAAA
• Sara A Waversveld, D.P.M.
• Jacqueline Wawa
• Rebecca Ann Wawrykow, RN
• Audrey Gayle Wayment
• Antoinette Evonne Wayne, LMP
• Darla Waynick, CP60387971
• Wayswithin

• Dentist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.