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General NPI Number Information
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NPI Number | 1972941094
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Entity Type | Organization
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Legal Business Name | BOGDAN N BODROUG, DDS, PS
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 2701 NE 114TH AVE SUITE 6
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City | VANCOUVER
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State | WA
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Zip | 98684-4289
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Country | US
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Telephone | 503-427-2984
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 NE 114TH AVE SUITE 6
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City | VANCOUVER
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State | WA
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Zip | 98684-4289
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Country | US
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Telephone | 503-427-2984
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JILLIAN N GOOD-BODROUG
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Credential | RDA
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Telephone | 503-490-1275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00010445
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License Number State | WA
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