# PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1851958029
- **Legal business name:** PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
- **Authorized official:** DR. SIMON BANGIYEV DDS, MD. (PRESIDENT)
- **Authorized official phone:** (203) 960-1960

## Contact information

- **Practice address:** 324 ELM ST STE 201A, MONROE, CT 06468-2282
- **Practice address phone:** (203) 690-1960
- **Mailing address:** 324 ELM ST STE 201A, MONROE, CT 06468-2282
- **Mailing address phone:** (203) 690-1960

## 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:** 05/23/2019
- **Last updated:** 05/23/2019