Bogdan N Bodroug, DDS, PS

Primary specialty

DentistTaxonomy code 122300000X

License

DE00010445 Issued in WA

Legal business name

BOGDAN N BODROUG, DDS, PS

Doing business as

Quality Dental Care

Practice address

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

Phone

(503) 427-2984

NPI assigned

Jun 11, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Jillian N Good-Bodroug, RDA

Title

Administrator

Phone

(503) 490-1275

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Quality Dental Care Doing business as

Locations

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1972941094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 NE 114TH AVE",
            "address_2": "SUITE 6",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844289",
            "telephone_number": "503-427-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 NE 114TH AVE",
            "address_2": "SUITE 6",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986844289",
            "telephone_number": "503-427-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOGDAN N BODROUG, DDS, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "GOOD-BODROUG",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "503-490-1275",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00010445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001307",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quality Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bernice Boehm-Soltero
• Kennedie Ann Boehm, DNP, FNP
• Rick D Boehm, LMHC, MAC, MS
• Krystle Boell
• Brittany Bogales
• Aleksey Bogdanov, LMT
• Liliya V Bogdanova
• Robert J Bogdon
• Mandy Boge, FNP
• Sara Marie Peters Boggis, MS

• 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 Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.