Organization
FAMILY DENTISTRY OF BRIDGEPORT P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK AGABABAEV DDS (PRESIDENT)
(718) 887-1397
Entity
Organization
Contact information
Practice address
90 BROOKLAWN AVE, BRIDGEPORT, CT 06604-2010
(203) 334-4837
Mailing address
90 BROOKLAWN AVE, BRIDGEPORT, CT 06604-2010
(203) 334-4837
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
010091
CT
Other
Enumeration date
08/23/2011
Last updated
08/23/2011
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