Provider Demographics
NPI:1528378395
Name:KHOLODENKO, YELENA (DDS, MS)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KHOLODENKO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ROZINA CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1317
Mailing Address - Country:US
Mailing Address - Phone:410-356-1224
Mailing Address - Fax:
Practice Address - Street 1:412 MALCOLM DR
Practice Address - Street 2:SUITE 208
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6115
Practice Address - Country:US
Practice Address - Phone:410-848-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics