Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Kelly Johanna Waggener, DMD

Individual provider General Practice Dentistry · NPI 1629111604

Dr. Kelly Johanna Waggener, DMD is a General Practice Dentistry in Santa Rosa, California. Licensed in California. Registered with an NPI since 2007.

Licensed in
CA
In the registry since
2007
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

80 Doctors Park Dr
Santa Rosa, CA 95405-6615
Phone: (707) 544-1836
Fax: (707) 542-0617
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 48404 (CA)

Record details

NPI number1629111604
Entity typeIndividual (Type 1)
GenderFemale
Credentials DMD
Sole proprietorNo
NPI enumeratedFebruary 15, 2007
Last updated in NPPESJuly 8, 2007

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