Organization
PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIMON Y BANGIYEV DDS, MD. (PRESIDENT)
(203) 690-1960
Entity
Organization
Contact information
Practice address
411 BARNUM AVENUE CUTOFF STE 5, STRATFORD, CT 06614-5100
(203) 960-1960
Mailing address
411 BARNUM AVENUE CUTOFF STE 5, STRATFORD, CT 06614-5100
(203) 960-1960
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
11114
CT
Other
Enumeration date
04/15/2018
Last updated
04/16/2018
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