Healthcare Provider Details

I. General information

NPI: 1649135138
Provider Name (Legal Business Name): STAMFORD IMPLANT & ORAL SURGERY CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SUMMER ST STE 300
STAMFORD CT
06905-5513
US

IV. Provider business mailing address

999 SUMMER ST STE 300
STAMFORD CT
06905-5513
US

V. Phone/Fax

Practice location:
  • Phone: 203-303-9693
  • Fax:
Mailing address:
  • Phone: 203-303-9693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMON Y BANGIYEV
Title or Position: PRESIDENT
Credential: DDS, MD.
Phone: 203-939-9390