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General NPI Number Information
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NPI Number | 1649135138
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Entity Type | Organization
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Legal Business Name | STAMFORD IMPLANT & ORAL SURGERY CENTER, PLLC
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 999 SUMMER ST STE 300
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City | STAMFORD
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State | CT
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Zip | 06905-5513
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Country | US
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Telephone | 203-303-9693
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Fax |
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Provider Business Mailing Address
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Address Line | 999 SUMMER ST STE 300
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City | STAMFORD
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State | CT
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Zip | 06905-5513
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Country | US
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Telephone | 203-303-9693
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SIMON Y BANGIYEV
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Credential | DDS, MD.
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Telephone | 203-939-9390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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