| NPI | 1952898025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMON Y BANGIYEV President 203-690-1960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 11114) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2018-04-16 |