DR. KELLY JOHANNA WAGGENER D.M.D
NPI 1629111604
Dentist - General Practice in Santa Rosa, CA

Q: What is Kelly Waggener's NPI number?

The NPI number for Kelly Waggener is 1629111604. It was assigned to this individual provider in the NPPES registry on February 15, 2007.

Q: What is Kelly Waggener's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Kelly Waggener was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 15, 2007

80 DOCTORS PARK DR, SANTA ROSA, CA 95405(707) 544-1836(707) 542-0617 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Dr. Kelly Johanna Waggener D.m.d NPPES

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

DR. KELLY JOHANNA WAGGENER D.M.D (NPI 1629111604) is an individual general practice provider in Santa Rosa, California, licensed in California (48404) and active in the NPI registry since February 2007.

NPPES Registry Identity

NPI1629111604

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameDR. KELLY JOHANNA WAGGENERCredential: D.M.D

Location Address80 DOCTORS PARK DRSanta Rosa, CA 95405-6615

Mailing Address80 Doctors Park DrSanta Rosa, CA 95405-6615 · (707) 544-1836 · Fax (707) 542-0617

Phone(707) 544-1836

Fax(707) 542-0617

Sole ProprietorNo

Enumeration DateFebruary 15, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1629111604 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in CA · 48404

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.

80 DOCTORS PARK DR, Santa Rosa, CA 95405

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Other Providers at the Same Location NPPES 2

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

DR. JASON THOMAS LEHMAN D.M.D

Dentist (General Practice)

80 DOCTORS PARK DR
SANTA ROSA, CA 95405

Sonoma County (707) 544-1836

DR. EDWIN LEONARD DEGOLIA D.D.S.

Dentist

80 DOCTORS PARK DR
SANTA ROSA, CA 95405

Sonoma County (707) 542-5125

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Waggener's NPI number?

The NPI number for Kelly Waggener is 1629111604. It was assigned to this individual provider in the NPPES registry on February 15, 2007.

Where is Kelly Waggener located?

Kelly Waggener practices at 80 Doctors Park Dr, Santa Rosa, CA 95405. The listed phone number is (707) 544-1836.

What is Kelly Waggener's specialty?

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

When was this NPI record last updated?

The NPPES record for Kelly Waggener was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.