Provider Demographics
NPI:1083837553
Name:ONDO, MICHAEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:ONDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SW SHEVLIN HIXON DR
Mailing Address - Street 2:STE. 1
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 SW SHEVLIN HIXON DR
Practice Address - Street 2:STE. 1
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3201
Practice Address - Country:US
Practice Address - Phone:541-383-7609
Practice Address - Fax:541-383-5965
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67931223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics