Provider Demographics
NPI:1417090556
Name:SHIRKIN, YELENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:SHIRKIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLD COURT ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6418
Mailing Address - Country:US
Mailing Address - Phone:410-764-3363
Mailing Address - Fax:410-764-0624
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:410-764-3363
Practice Address - Fax:410-764-0624
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice