Organization
PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIMON BANGIYEV DDS, MD (OWNER)
(203) 303-9693
Entity
Organization
Contact information
Practice address
211 E PUTNAM AVE STE 2-6, COS COB, CT 06807-2734
(203) 303-9693
Mailing address
346 MAIN AVE STE H, NORWALK, CT 06851-6406
(203) 939-9390
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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