Provider Demographics
NPI:1558686998
Name:GOLOBORODKO, YELENA (BS, RDH)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:GOLOBORODKO
Suffix:
Gender:F
Credentials:BS, RDH
Other - Prefix:
Other - First Name:ALYONA
Other - Middle Name:
Other - Last Name:GOLOBORODKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:421 SW OAK ST
Mailing Address - Street 2:STE.210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1817
Mailing Address - Country:US
Mailing Address - Phone:503-988-7468
Mailing Address - Fax:503-988-3015
Practice Address - Street 1:600 NE 8TH ST FL 3
Practice Address - Street 2:DENTAL CLINIC
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7317
Practice Address - Country:US
Practice Address - Phone:503-988-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5346124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist