Stephen Waterman IV, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE00005768 Issued in WA

Practice address

15224 Main St.
Suite 300
Mill Creek, WA 98912

Phone

(425) 379-8020

Fax

(425) 379-8022

NPI assigned

Oct 5, 2006

Last updated

Feb 21, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: swaterman452911@direct.multicare.org

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.

• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bellevue, WA
  • NPI 1942665831

  Dentist

  NPD (past)
• Sea Mar Specialty Dental Group

  • Specialist
  • Bellevue, WA
  • NPI 1568981470
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1578659389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15224 MAIN ST.",
            "address_2": "SUITE 300",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "98912",
            "telephone_number": "425-379-8020",
            "fax_number": "425-379-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15224 MAIN ST.",
            "address_2": "SUITE 300",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "98912",
            "telephone_number": "425-379-8020",
            "fax_number": "425-379-8022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 116th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Bellevue",
            "state": "WA",
            "postal_code": "980043047",
            "country_code": "US",
            "telephone_number": "425-998-5090",
            "fax_number": "425-998-5099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8915 14th Ave S Fl 2",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981084813",
            "country_code": "US",
            "telephone_number": "206-762-3263",
            "fax_number": "206-763-6574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "STEPHEN",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00005768",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00005768",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Wang, O.D.
• Jason Wang
• Washington CVS Pharmacy LLC (CVS Pharmacy #11650)
• Washington Physical Therapy Services of Mill Creek, LLC (Apex Health And Rehab)
• Rebekah Watanabe
• Joan Weisbergbeyerlein
• Sheila M Weisbrod
• Eden Weldetnsae, OD
• Mary M Wergeland, O.T.
• Sandra J. Weyrauch, PT

• Dentist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.