DR. SERENA AUTUMN WATERWORTH DMD NPI 1043057334

NPI Information

  • NPI: 1043057334
  • Provider Name: DR. SERENA AUTUMN WATERWORTH, DMD
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 387 NE 223RD AVE
    GRESHAM, OR
    ZIP 97030
  • Phone: (503) 491-5450

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NPI Details

DR. Serena Autumn Waterworth, DMD is a general practice dentist in Gresham, OR. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Serena Autumn Waterworth, DMD NPI is 1043057334. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

387 NE 223RD AVE
GRESHAM, OR
ZIP 97030-554
Phone: (503) 491-5450

The NPI 1043057334 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 7/12/2024 and was last updated on 7/12/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral PracticeD12035OREGONYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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