Provider Demographics
NPI:1295877199
Name:D'AGOSTINO FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:D'AGOSTINO FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-239-2050
Mailing Address - Street 1:21 WASHINGTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2310
Mailing Address - Country:US
Mailing Address - Phone:203-239-2050
Mailing Address - Fax:
Practice Address - Street 1:21 WASHINGTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2310
Practice Address - Country:US
Practice Address - Phone:203-239-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0065041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty