Maxim A Kondratenko, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.00206311 Issued in CO

Practice address

1250 Valley View Dr
Delta, CO 81416-3138

Phone

(970) 874-8981

Fax

(855) 299-7586

NPI assigned

May 1, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: maxim.kondratenko.1@19850.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Olathe Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Olathe, CO
  • NPI 1770834244
  Medicare reassignment NPD
• Olathe Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Delta, CO
  • NPI 1558886218
  NPD (past)
• Olathe Community Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • Montrose, CO
  • NPI 1245600493
  NPD (past)

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

{
    "created_epoch": "1746057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768521600000",
    "number": "1679362180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 529",
            "city": "OLATHE",
            "state": "CO",
            "postal_code": "814250529",
            "telephone_number": "970-323-6141",
            "fax_number": "855-299-8071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 VALLEY VIEW DR",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814163138",
            "telephone_number": "970-874-8981",
            "fax_number": "855-299-7586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 S Rio Grande Ave",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "CO",
            "postal_code": "814014831",
            "country_code": "US",
            "telephone_number": "970-497-3333",
            "fax_number": "855-299-7837",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "308 Main St",
            "address_purpose": "LOCATION",
            "city": "Olathe",
            "state": "CO",
            "postal_code": "814255066",
            "country_code": "US",
            "telephone_number": "970-323-6141",
            "fax_number": "855-299-8071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONDRATENKO",
        "first_name": "MAXIM",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-01",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00206311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "900246427",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• John P Knutson, MD
• Sara W Knutson, MD
• Elizabeth Kotwasinski, MSW
• Kyle Nickel MD, PC
• Lake Island Healthcare, Inc.
• Joshua Lake
• Kenneth B Lake, CRNA

• Dentist in Delta, CO
• Providers in Delta, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.