Provider Demographics
NPI:1447035183
Name:ZAGORODNY, HELEN ALEXANDRA (DMD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:ALEXANDRA
Last Name:ZAGORODNY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10509 NE 123RD PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1856
Mailing Address - Country:US
Mailing Address - Phone:360-356-5575
Mailing Address - Fax:
Practice Address - Street 1:14411 NE FOURTH PLAIN BLVD UNIT 134
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5001
Practice Address - Country:US
Practice Address - Phone:360-768-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11847122300000X
WADE61468669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist