Provider Demographics
NPI:1366671281
Name:BANGIYEV, SIMON (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:BANGIYEV
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 MAIN AVE STE H
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1592
Mailing Address - Country:US
Mailing Address - Phone:203-939-9390
Mailing Address - Fax:203-939-9391
Practice Address - Street 1:346 MAIN AVE STE H
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1592
Practice Address - Country:US
Practice Address - Phone:203-939-9390
Practice Address - Fax:203-939-9391
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0566501223S0112X
CT111141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery