# PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518794338
- **Authorized official:** DR. SIMON BANGIYEV DDS, MD (OWNER)
- **Authorized official phone:** (203) 303-9693

## Contact information

- **Practice address:** 211 E PUTNAM AVE STE 2-6, COS COB, CT 06807-2734
- **Practice address phone:** (203) 303-9693
- **Mailing address:** 346 MAIN AVE STE H, NORWALK, CT 06851-6406
- **Mailing address phone:** (203) 939-9390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/16/2024
- **Last updated:** 09/16/2024