Bogdan Nikolayevich Bodroug, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D8513 Issued in OR

Practice address

2701 NE 114TH Ave Ste 6
Vancouver, WA 98684-4289

Phone

(360) 448-7018

Fax

(360) 828-5234

NPI assigned

Dec 11, 2006

Last updated

Dec 28, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451260800000",
    "number": "1710047410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 NE 114TH AVE STE 6",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844289",
            "telephone_number": "360-448-7018",
            "fax_number": "360-828-5234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 NE 114TH AVE STE 6",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844289",
            "telephone_number": "360-448-7018",
            "fax_number": "360-828-5234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODROUG",
        "first_name": "BOGDAN",
        "middle_name": "NIKOLAYEVICH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2015-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8513",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010445",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2028322",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Boda, RDN
• Sara Michelle Bodack, AU.D.
• Karen Bode, LMP
• Amanda Boden
• Bernadette Bodle, LMP
• Body in Balance Chiropractic and Wellness Center
• Body Injury & Rehab P.C.
• Body Vitality LLC
• Bodyfit Chiropractic
• Bodyfit Chiropractic

• Dentist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; 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.