Tesha Lynn Waggoner, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D10820 Issued in OR

Practice address

150 SE 3Rd Ave
Hillsboro, OR 97123

Phone

(503) 213-1257

Fax

(503) 213-1258

NPI assigned

Jun 26, 2014

Sex

Female

Sole proprietor

No

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

Locations

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.

• Tesha Waggoner DMD PC

  • Pediatric Dentistry
  • Portland, OR
  • NPI 1790558997
  NPD Authorized official
• Waggoner Dentistry PC

  • Pediatric Dentistry
  • Lake Oswego, OR
  • NPI 1093646085
  NPD Authorized official
• Advantage Dental Group, PC

  • General Practice Dentistry
  • Bend, OR
  • NPI 1972970671
  NPD (past)

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535328000000",
    "number": "1821403924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14201 NE 20TH AVE STE B200",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986866412",
            "telephone_number": "360-571-8181",
            "fax_number": "360-573-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SE 3RD AVE",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "97123",
            "telephone_number": "503-213-1257",
            "fax_number": "503-213-1258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Punchbowl St",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968132402",
            "country_code": "US",
            "telephone_number": "808-691-4292",
            "fax_number": "808-691-5028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "TESHA",
        "middle_name": "LYNN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-26",
        "last_updated": "2018-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "HI",
            "license": "DTT 242",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D10820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hoang Lan Phuong Vu
• Jonathan Vu, LMT
• Maryann Tuyet-Nhu Vu
• Scully Vue, M.A.
• Shannon Vuylsteke, EFDA
• Brady Wayne Wagner, M.D.
• Justus Wahl
• Tracy Wahlberg, M.S.
• Alisa B. Waibel, DPT
• Kathryn Sue Waibel, RN

• Pediatric Dentistry in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2018; 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.