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Organization
PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
Active
Organization
PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIMON BANGIYEV DDS, MD (OWNER)
(203) 303-9693
Entity
Organization
Contact information
Practice address
211 E PUTNAM AVE STE 2-6, COS COB, CT 06807-2734
(203) 303-9693
Mailing address
346 MAIN AVE STE H, NORWALK, CT 06851-6406
(203) 939-9390
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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