# PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC

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

## Provider details

- **NPI number:** 1952898025
- **Authorized official:** DR. SIMON Y BANGIYEV DDS, MD. (PRESIDENT)
- **Authorized official phone:** (203) 690-1960

## Contact information

- **Practice address:** 411 BARNUM AVENUE CUTOFF STE 5, STRATFORD, CT 06614-5100
- **Practice address phone:** (203) 960-1960
- **Mailing address:** 411 BARNUM AVENUE CUTOFF STE 5, STRATFORD, CT 06614-5100
- **Mailing address phone:** (203) 960-1960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 11114 | CT | Yes |

## Other

- **Enumeration date:** 04/15/2018
- **Last updated:** 04/16/2018