Individual
DR. SERENA AUTUMN WATERWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
387 NE 223RD AVE, GRESHAM, OR 97030-8554
(503) 491-5450
Mailing address
1268 NE 186TH DR, PORTLAND, OR 97230-7127
(503) 530-0609
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12035
OR
Other
Enumeration date
07/12/2024
Last updated
07/12/2024
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