Healthcare Provider Details

I. General information

NPI: 1326840190
Provider Name (Legal Business Name): VICTORIA D'AGOSTINO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N MAIN ST
WALLINGFORD CT
06492-3726
US

IV. Provider business mailing address

205 N MAIN ST
WALLINGFORD CT
06492-3726
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-1250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14809
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: