Healthcare Provider Details

I. General information

NPI: 1346927860
Provider Name (Legal Business Name): REGINA AGABABAEV DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAYA AGABABAEV DDS

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CONNECTICUT AVE
NORWALK CT
06854-1743
US

IV. Provider business mailing address

550 CONNECTICUT AVE
NORWALK CT
06854-1743
US

V. Phone/Fax

Practice location:
  • Phone: 203-855-7556
  • Fax:
Mailing address:
  • Phone: 203-855-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14410
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: