Individual
TESHA LYNN WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
150 SE 3RD AVE, HILLSBORO, OR 97123
(503) 213-1257
(503) 213-1258
Mailing address
14201 NE 20TH AVE STE B200, VANCOUVER, WA 98686-6412
(360) 571-8181
(360) 573-4022
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DTT 242
HI
1223P0221X
Pediatric Dentistry
Primary
D10820
OR
Other
Enumeration date
06/26/2014
Last updated
08/27/2018
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