Provider Demographics
NPI:1245538800
Name:SHARGORODSKAYA, YELENA (DDS)
Entity type:Individual
Prefix:MS
First Name:YELENA
Middle Name:
Last Name:SHARGORODSKAYA
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 1:3311 SHORE PKWY APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3942
Mailing Address - Country:US
Mailing Address - Phone:718-743-0299
Mailing Address - Fax:718-743-1468
Practice Address - Street 1:1725 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3606
Practice Address - Country:US
Practice Address - Phone:718-743-0299
Practice Address - Fax:718-743-1468
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist