Individual provider Active NPI

Mikhail Bondarew, DDS

  • Dentist
  • Portland, OR
National Provider Identifier
1124530043
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D10788 Issued in OR
Practice address
18633 SE Stark St Ste 401
Portland, OR 97233-5468
Phone
(503) 489-1760
NPI assigned
Nov 1, 2017
Last updated
Aug 27, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D10788 OR Primary

Addresses

Primary practice location

18633 SE Stark St Ste 401
Portland, OR 97233-5468

Mailing address

18633 SE Stark St Ste 401
Portland, OR 97233-5468
Phone (503) 489-1760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181010001256 OR Order and Referring Only - DentistPractitioner - Dentist 3274885801

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D10788ORMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1124530043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18633 SE STARK ST STE 401",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335468",
            "telephone_number": "503-489-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18633 SE STARK ST STE 401",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972335468",
            "telephone_number": "503-489-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONDAREW",
        "first_name": "MIKHAIL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-01",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.