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Organization
ORAL MAXILLOFACIAL SURGERY FAIRFIELD COUNTY LLC
Active
Organization
ORAL MAXILLOFACIAL SURGERY FAIRFIELD COUNTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IMANUEL BABAYEV DDS, MD (OWNER)
(718) 666-6664
Entity
Organization
Contact information
Practice address
148 EAST AVE STE 3H1, NORWALK, CT 06851-5721
(718) 666-6664
Mailing address
148 EAST AVE STE 3H1, NORWALK, CT 06851-5721
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
12/22/2016
Last updated
12/22/2016
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