Provider Demographics
NPI:1740629781
Name:YELENA KHOLODENKO, D.D.S., LLC
Entity type:Organization
Organization Name:YELENA KHOLODENKO, D.D.S., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOLODENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:410-848-7060
Mailing Address - Street 1:412 MALCOLM DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6115
Mailing Address - Country:US
Mailing Address - Phone:410-848-7060
Mailing Address - Fax:
Practice Address - Street 1:412 MALCOLM DR
Practice Address - Street 2:SUITE 304
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty