Premier Oral Surgery and Implantology Center LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC

Practice address

324 Elm St Ste 201a
Monroe, CT 06468-2282

Phone

(203) 690-1960

NPI assigned

May 23, 2019

Last updated

May 23, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Simon Bangiyev, DDS, MD.

Title

President

Phone

(203) 960-1960

Specialties & licenses 1

Addresses

Tax ID family

Premier Oral Surgery and Implantology Center LLC3 organizations share this tax ID, including this one

Part of

Premier Oral Surgery and Implantology Center LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Premier Oral Surgery and Implantology Center LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Cos Cob, CT
  • NPI 1518794338
  NPD tax ID
• Premier Oral Surgery and Implantology Center LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Stratford, CT
  • NPI 1952898025
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1851958029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 ELM ST STE 201A",
            "city": "MONROE",
            "state": "CT",
            "postal_code": "064682282",
            "telephone_number": "203-690-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 ELM ST STE 201A",
            "city": "MONROE",
            "state": "CT",
            "postal_code": "064682282",
            "telephone_number": "203-690-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC",
        "enumeration_date": "2019-05-23",
        "last_updated": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "BANGIYEV",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-960-1960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Monroe, CT
• Providers in Monroe, CT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.