| NPI | 1861939456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMON Y BANGIYEV President 203-939-9390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 011114) |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2017-01-20 |