Sally D Wiedeman, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

H6804 Issued in OR

Practice address

12750 SE Stark St BLDG E
Portland, OR 97233-1539

Phone

(971) 347-3009

Fax

(971) 256-3277

NPI assigned

Oct 28, 2015

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1427420470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 SE CARUTHERS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144502",
            "telephone_number": "503-224-1044",
            "fax_number": "971-260-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12750 SE STARK ST BLDG E",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331539",
            "telephone_number": "971-347-3009",
            "fax_number": "971-256-3277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEMAN",
        "first_name": "SALLY",
        "middle_name": "D",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-28",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "OR",
            "license": "H6804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500695952",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kara M Widergren
• Andrew S Widman, DO
• Peter Clair Robinson Widmer
• Mandie Wiebers Jensen, M.D.
• Blake Carlton Wieczorek
• Cindy Wiedoff
• Emily Wieland
• Brittany R Wienholz, LCSW
• Jennifer Dianne Wiens, PSY.D
• Taiya Wiers

• Dental Hygienist in Portland, OR
• Providers in Portland, OR by specialty
• Dental Hygienist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; 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.