A&G Family Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

010091 Issued in CT

Legal business name

A&G FAMILY DENTISTRY PC

Practice address

1127 W Main St
Ste 2a
Waterbury, CT 06708-2764

Phone

(203) 573-9989

NPI assigned

May 27, 2011

Last updated

May 27, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Agababaev, DDS

Title

Vice President

Phone

(718) 887-1397

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306454400000",
    "number": "1790078418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2354 OCEAN PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112235447",
            "telephone_number": "718-887-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 W MAIN ST",
            "address_2": "STE 2A",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082764",
            "telephone_number": "203-573-9989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A&G FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-27",
        "last_updated": "2011-05-27",
        "status": "A",
        "authorized_official_last_name": "AGABABAEV",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "718-887-1397",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "010091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.