Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1235839259 Individual Practitioner Male Practitioner

Marco Oktoviator Waworuntu

Dentist • Tacoma, WA

Professional Overview & Biography Verified Profile Summary

Marco Waworuntu is a registered healthcare professional specializing in Dentist in Tacoma, WA. Practice services are available at 5003 TACOMA MALL BLVD STE 103 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

5003 Tacoma Mall Blvd Ste 103

Tacoma, WA 984097120

Telephone 2538818780
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Tacoma, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 13.5 Yrs
State Avg: 16.1 Yrs
Regional Practice Density
145 Specialists

Practicing in Tacoma, WA (2853 Statewide)

Telehealth Adoption Rate
0.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-08-14
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License WA 61565869

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Secondary Practice Locations

11201 88th Ave E Ste 110

Puyallup, WA 983733802

Phone: 2538482988

18710 Meridian E Ste 216

Puyallup, WA 983752231

Phone: 2533211198

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1811703614

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
📍
Updated Practice Location August 14, 2024

Registered at 5003 TACOMA MALL BLVD STE 103, TACOMA, WA 984097120 (Tel: 2538818780)

📍
Updated Business Mailing Address August 14, 2024

Registered at 5003 TACOMA MALL BLVD, TACOMA, WA 984097120

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 14, 2024

Dentist (License #61565869 in WA)

📍
Updated Practice Location May 23, 2023

Registered at 7703 FLOYD CURL DR, SAN ANTONIO, TX 782293901 (Tel: 2104503700)

NPI Profile Active March 08, 2023

NPI status registered as active in NPPES database

📍
Updated Practice Location March 08, 2023

Registered at 5512 SUMMERHILL LN, TEMPLE, TX 765023989 (Tel: 2549314987)

📍
Updated Business Mailing Address March 08, 2023

Registered at 5512 SUMMERHILL LN, TEMPLE, TX 765023989 (Tel: 2549314987)

👤
Provider Name / Credentials Updated March 08, 2023

Recorded as MARCO WAWORUNTU

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 08, 2023

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration March 08, 2023

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1235839259
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 08, 2023
Last Update: August 14, 2024
Sole Proprietor: No

Mailing Address

5003 Tacoma Mall Blvd

Tacoma, WA 984097120

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.