Organization
TESHA WAGGONER DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TESHA LYNN WAGGONER DMD (OWNER)
(503) 292-9274
Entity
Organization
Contact information
Practice address
5415 SW WESTGATE DR., SUITE 207, PORTLAND, OR 97221
(503) 292-9274
(503) 445-0043
Mailing address
5415 SW WESTGATE DR., SUITE 207, PORTLAND, OR 97221
(503) 292-9274
(503) 445-0043
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500748806
—
OR
Enumeration date
10/31/2023
Last updated
10/31/2023
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