Provider Demographics
NPI:1366619785
Name:TKACHENKO-VAYNSHTEYN, YELENA (DDS)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:TKACHENKO-VAYNSHTEYN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:TKACHENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:138 BROADWAY
Mailing Address - Street 2:UNIT#1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8747
Mailing Address - Country:US
Mailing Address - Phone:718-599-6050
Mailing Address - Fax:718-599-6085
Practice Address - Street 1:138 BROADWAY
Practice Address - Street 2:UNIT#1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8747
Practice Address - Country:US
Practice Address - Phone:718-599-6050
Practice Address - Fax:718-599-6085
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048914-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist