Provider Demographics
NPI:1922154830
Name:KHRAPKO, YELENA (DDS)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:KHRAPKO
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 1:12 IROQUOIS ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4009
Mailing Address - Country:US
Mailing Address - Phone:917-748-6414
Mailing Address - Fax:203-324-9665
Practice Address - Street 1:100 GREYROCK PL
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3118
Practice Address - Country:US
Practice Address - Phone:203-348-0300
Practice Address - Fax:203-324-9665
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002088567Medicaid