Provider Demographics
NPI:1700445194
Name:SIMON BANGIYEV DDS, MD, PC
Entity Type:Organization
Organization Name:SIMON BANGIYEV DDS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:718-805-6000
Mailing Address - Street 1:10232 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2009
Mailing Address - Country:US
Mailing Address - Phone:718-805-6000
Mailing Address - Fax:
Practice Address - Street 1:10232 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2009
Practice Address - Country:US
Practice Address - Phone:718-805-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMON BANGIYEV, DDS, MD, PC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty