NPIMap

Organization Active NPI

Ken W. Waddell, DMD P.C.

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1356530422
Registry record updated Oct 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D5796 Issued in OR
Legal business name
KEN W. WADDELL, DMD P.C.
Practice address
15495 SW Sequoia Pkwy
Suite 120
Portland, OR 97224-6100
Phone
(503) 684-8445
NPI assigned
Oct 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2007

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

Authorized official

Name
Dr. Ken W Waddell, DMDNPI 1134239155
Title
Owner
Phone
(503) 684-8445

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 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

Other names 1

  • Dental Professional Doing business as

National Provider Directory

National Provider Directory

Locations

15495 SW Sequoia Pkwy
Ste 120
Tigard, OR 97224
Phone (503) 684-8445

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1356530422",
    "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": {
        "organization_name": "KEN W. WADDELL, DMD P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "KEN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-684-8445",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D5796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Professional",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 15, 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.

Verify at the official NPI Registry.