DR. SERENA AUTUMN WATERWORTH-WEST DMD
NPI 1043057334
Dentist - General Practice in Gresham, OR

Q: What is Serena Waterworth-west's NPI number?

The NPI number for Serena Waterworth-west is 1043057334. It was assigned to this individual provider in the NPPES registry on July 12, 2024.

Q: What is Serena Waterworth-west's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since July 12, 2024PECOS Enrolled

387 NE 223RD AVE, GRESHAM, OR 97030(503) 491-5450 Get Directions Write a Review

NPPES record last updated: May 12, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 12, 2026, Jul 12, 2024 (2 updates tracked since 2024).

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About Dr. Serena Autumn Waterworth-west Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SERENA AUTUMN WATERWORTH-WEST DMD (NPI 1043057334) is an individual general practice provider in Gresham, Oregon, licensed in Oregon (D12035) and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1043057334

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameDR. SERENA AUTUMN WATERWORTH-WESTCredential: DMD

Location Address387 NE 223RD AVEGresham, OR 97030-8554

Mailing Address1268 Ne 186th DrPortland, OR 97230-7127 · (503) 530-0609

Phone(503) 491-5450

Sole ProprietorNo

Enumeration DateJuly 12, 2024

Last NPPES UpdateMay 12, 20262 updates tracked since enumeration

NPPES CertifiedMay 12, 2026

✔ NPI 1043057334 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in OR · D12035

Definition

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.

387 NE 223RD AVE, Gresham, OR 97030

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Serena Autumn Waterworth-west Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$73.28 typical visit price

range $19.32 – $144.79

Typical copayment $18.32 (range $4.83 – $36.19)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FRANK JAMES FOREMAN DDS

Dentist (Pediatric Dentistry)