Provider Demographics
NPI:1629182035
Name:BRODSKY, ZORYANA LOGVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZORYANA
Middle Name:LOGVIN
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 NE 20TH AVE
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6410
Mailing Address - Country:US
Mailing Address - Phone:360-571-8181
Mailing Address - Fax:360-573-4029
Practice Address - Street 1:13908 SE STARK ST
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2161
Practice Address - Country:US
Practice Address - Phone:503-255-9795
Practice Address - Fax:503-255-9793
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice