# ORAL MAXILLOFACIAL SURGERY FAIRFIELD COUNTY LLC

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

## Provider details

- **NPI number:** 1699210922
- **Authorized official:** DR. IMANUEL BABAYEV DDS, MD (OWNER)
- **Authorized official phone:** (718) 666-6664

## Contact information

- **Practice address:** 148 EAST AVE STE 3H1, NORWALK, CT 06851-5721
- **Practice address phone:** (718) 666-6664
- **Mailing address:** 148 EAST AVE STE 3H1, NORWALK, CT 06851-5721

## 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:** 12/22/2016
- **Last updated:** 12/22/2016