Premier Oral Surgery and Implantology Center LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

11114 Issued in CT

Legal business name

PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC

Practice address

411 Barnum Avenue Cutoff Ste 5
Stratford, CT 06614-5100

Phone

(203) 960-1960

NPI assigned

Apr 15, 2018

Last updated

Apr 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Simon Y Bangiyev, DDS, MD.

Title

President

Phone

(203) 690-1960

Specialties & licenses 1

Addresses

Tax ID family

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

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)
  • Monroe, CT
  • NPI 1851958029
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Seth Benjamin Greenberg

  • Oral and Maxillofacial Surgery (Dentist)
  • Stratford, CT
  • NPI 1588070452
  NPD (past)

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

{
    "created_epoch": "1523750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1952898025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 BARNUM AVENUE CUTOFF STE 5",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066145100",
            "telephone_number": "203-960-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 BARNUM AVENUE CUTOFF STE 5",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066145100",
            "telephone_number": "203-960-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-15",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "BANGIYEV",
        "authorized_official_first_name": "SIMON",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-690-1960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "11114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bianka Kamille Pizarro, FNP-C
• Doris Plavnicky
• Kathleen Porto, PT
• Paulette Iris Powell-Reeves, LPC
• Precision Hearing Specialists, LLC
• Premise Health of Connecticut Medical, P.C. (The Wellness Center operated by Premise Health)
• Anne Pretty, LCSW
• Heather Previs
• Robert Scott Prewitt, M.D.
• Primary Care Associates,PC

• Oral and Maxillofacial Surgery (Dentist) in Stratford, CT
• Providers in Stratford, 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 Apr 16, 2018; 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.