Family Dentistry of Derby P.C

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FAMILY DENTISTRY OF DERBY P.C

Practice address

115 New Haven Ave
Derby, CT 06418-2154

Phone

(203) 751-9657

Fax

(203) 751-9827

NPI assigned

Dec 27, 2012

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

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": "1356566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414540800000",
    "number": "1881930501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 NEW HAVEN AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182154",
            "telephone_number": "203-751-9657",
            "fax_number": "203-751-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 NEW HAVEN AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182154",
            "telephone_number": "203-751-9657",
            "fax_number": "203-751-9827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTISTRY OF DERBY P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-27",
        "last_updated": "2014-10-29",
        "status": "A",
        "authorized_official_last_name": "AGABABAEV",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-887-1397",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Ernst, MS,RD,CDN
• Victoria Espiritusanto-Diaz
• Golfam Fadaei, MD
• Jennifer Fairchild, LCSW
• Julie Falcone, LCSW
• Alexandra Farley, MSW
• Cecilia Marie Fernandes, RDH
• Gerald George Fette, M.D.
• Helen J Fischer, LCSW
• Joao Daniel Trindade Fontes, MD

• General Practice Dentistry in Derby, CT
• Providers in Derby, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; 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.