Keegan Joseph Waldo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60769612 Issued in WA

Practice address

2625 Wheaton Way Ste D
Bremerton, WA 98310-3372

Phone

(360) 373-2539

NPI assigned

May 23, 2017

Last updated

Jul 21, 2022By 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

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.

• Current Dental

  • Dentist
  • Bremerton, WA
  • NPI 1669629374
  NPD (past)

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

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1821526708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 WHEATON WAY STE D",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103372",
            "telephone_number": "360-373-2539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 WHEATON WAY STE D",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103372",
            "telephone_number": "360-373-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDO",
        "first_name": "KEEGAN",
        "middle_name": "JOSEPH",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-23",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "WA",
            "license": "RR60670198",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60769612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendi Wainscott
• Athena Wakonabo
• Wal-Mart Stores, Inc (Vision Center 30-2317)
• Jenny Waldbillig
• Leslie Ann Waldman, M.D.
• Aaron Lee Waley, SUDPT
• Walgreen Co (Walgreens #12168)
• Walgreen Co (Walgreens #06423)
• Walgreen Co (Walgreens #05912)
• Amy Walker-Banks

• General Practice Dentistry in Bremerton, WA
• Providers in Bremerton, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.