Konstantin V Amirzadov, DMD
Individual provider Active NPI General Practice Dentistry · Lowell, MA
NPI 1598891020 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1598891020
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 18197 (MA)
- Practice address
- 133 Market Street
Lowell, MA 01852 - Phone
- (978) 458-1179
- Fax
- (978) 805-1415
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18197 | MA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 18197 | MA | Yes |
Addresses
Primary practice location
133 Market Street
Lowell, MA 01852
Mailing address
133 Market Street
Lowell, MA 01852
Phone (978) 458-1179
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| X11615 | Other | MA | BLUE CROSS BLUE SHIELD |
| 2752307 | Medicaid | MA |
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All providers in Lowell, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.