Organization
PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
Active
Parent organization
PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
Authorized official
DR. SIMON BANGIYEV DDS, MD. (PRESIDENT)
(203) 960-1960
Entity
Organization
Contact information
Practice address
324 ELM ST STE 201A, MONROE, CT 06468-2282
(203) 690-1960
Mailing address
324 ELM ST STE 201A, MONROE, CT 06468-2282
(203) 690-1960
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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