PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC (NPI# 1952898025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952898025 |
| Entity Type | Organization |
| Organization Name | PREMIER ORAL SURGERY AND IMPLANTOLOGY CENTER LLC |
| Practice Address |
411 Barnum Avenue Cutoff Ste 5 Stratford CT 06614-5100 |
| Practice Telephone | 2039601960 |
| Mailing Telephone | 2039601960 |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2018-04-16 |
| Authorized Official Name | DR. SIMON Y BANGIYEV (PRESIDENT) |
| Authorized Official Telephone | 2036901960 |
| Authorized Official Credential | DDS, MD. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
11114 | CT | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851958029 | Premier Oral Surgery and Implantology Center LLC | Dentist | 324 Elm St Ste 201a, Monroe, CT 06468-2282 | 2019-05-23 |
| Street Address |
411 BARNUM AVENUE CUTOFF STE 5 |
| City | STRATFORD |
| State | CT |
| Zip Code | 06614-5100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588139604 | David A Crosby | Physician Assistant | 125 Pumpkin Ground Road, Stratford, CT 06614 | 2018-10-04 |
| 1710489232 | Karen Marie Laconte | Naturopath | 720 Hilltop Dr, Stratford, CT 06614 | 2018-02-28 |
| 1972024693 | Amanda Wilson | Social Worker | 60 Edmund Street, Stratford, CT 06614 | 2017-07-03 |
| 1558801423 | Kristine Lynn Conlan | Physical Therapist | 55 Pasadena Ave., Stratford, CT 06614 | 2017-02-27 |
| 1811440258 | Seokwon Kwon | Dentist | 320 Boston Ave, Stratford, CT 06614 | 2016-08-02 |
| 1093176141 | Kathleen G Domek | Technician/Technologist | 150 Barnum Avenue Cut Off, Stratford, CT 06614 | 2016-03-17 |
| 1417328634 | Kelley Machado | Social Worker | 2127 Nichols Ave, Stratford, CT 06614 | 2015-10-14 |
| 1043629553 | Jennifer Woods-mesquita | Social Worker | 125 Greenlawn Ave, Stratford, CT 06614 | 2014-08-08 |
| 1437564010 | Jose R. Pacheco | Obstetrics & Gynecology | 120 Brightwood Ave, Stratford, CT 06614 | 2014-06-23 |
| 1740612829 | Stanley Brovender | General Practice | 773b Pontiac Lane, Stratford, CT 06614 | 2013-07-31 |
| Find all providers in zip 06614 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134148984 | David Martin Pagar | Dentist | 2900 Main St Ste 2e, Unit 2e, Stratford, CT 06614-4946 | 2006-07-19 |
| 1780690412 | Ira N Slow | Dentist | 1825 Barnum Ave, Suite 303, Stratford, CT 06614-5333 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053951350 | Connecticut Oral Surgery and Implant Center, Pllc | Dentist | 314 Flanders Rd Ste 1b, East Lyme, CT 06333-1727 | 2020-01-14 |
| 1629595145 | Gary Fishbein Dmd LLC | Dentist | 281 Hartford Tpke Ste 307, Vernon, CT 06066-4707 | 2017-08-25 |
| 1912428160 | Gm Surgical Associates LLC | Dentist | 130 New London Tpke Ste 3, Norwich, CT 06360-2624 | 2017-06-28 |
| 1861920068 | Mofs-ct Oral Facial Surgery LLC | Dentist | 1 Boulder Ave, Old Greenwich, CT 06870-1420 | 2017-06-01 |
| 1881034262 | Christy Lottinger | Dentist | 263 Farmington Ave # Mc1710, Farmington, CT 06030-1267 | 2013-06-28 |
| 1558618025 | Priceless Dental Care P.C. | Dentist | 60 Waterbury Rd Ste E, Prospect, CT 06712-1251 | 2012-08-14 |
| 1477840270 | Imanuel Babayev | Dentist | 148 East Ave Ste 3h1, Norwalk, CT 06851-5721 | 2011-06-30 |
| 1629364997 | New London Dental Care, LLC | Dentist | 258 S Frontage Rd, New London, CT 06320-2641 | 2011-06-24 |
| 1952600595 | James M. Lee | Dentist | 366 Munger Lane, Bethlehem, CT 06751-1100 | 2011-03-22 |
| 1366671281 | Simon Bangiyev | Dentist | 346 Main Ave Ste H, Norwalk, CT 06851-1592 | 2009-07-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.