# WAGGONER DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093646085
- **Authorized official:** DR. TESHA WAGGONER DMD (OWNER)
- **Authorized official phone:** (503) 292-9274

## Contact information

- **Practice address:** 15962 BOONES FERRY RD STE 208, LAKE OSWEGO, OR 97035-4360
- **Practice address phone:** (503) 292-9274
- **Mailing address:** 5415 SW WESTGATE DR STE 207, PORTLAND, OR 97221-2429
- **Mailing address phone:** (503) 292-9274

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2026
- **Last updated:** 05/27/2026