Provider Demographics
NPI:1346862570
Name:ADINYAGUEV, SHANDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANDE
Middle Name:
Last Name:ADINYAGUEV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4205
Mailing Address - Country:US
Mailing Address - Phone:203-865-1480
Mailing Address - Fax:203-865-0290
Practice Address - Street 1:1574 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4205
Practice Address - Country:US
Practice Address - Phone:203-865-1480
Practice Address - Fax:203-865-0290
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT129011223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice