Individual
TATIANA AGABABAEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
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
122300000X
Dentist
Primary
11641
CT
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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