Khosrow Benjamin Azizi, D.M.D.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Glenside, PA
NPI 1881744563 · NPPES record last updated Dec 17, 2019
Key facts
- NPI
- 1881744563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- DS025908L (PA)
- Practice address
- 242 N Keswick Ave
Glenside, PA 19038-4804 - Phone
- (215) 576-6414
- Fax
- (215) 576-8497
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
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 |
|---|---|---|---|
| DS025908L | PA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Benjamin K Azizi | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DS025908L | PA | Yes |
Addresses
Primary practice location
242 N Keswick Ave
Glenside, PA 19038-4804
Mailing address
242 N Keswick Ave
Glenside, PA 19038-4804
Phone (215) 576-6414
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 505604 | Other | PA | UNITED CONCORDIA ID NUMBE |
Other names
- Dr. Benjamin K Azizi
Other providers in Glenside, PA
- Am PM North America Inc.
- Francis Anthony Angiolillo
- Eileen Anne Araco
- Raechel E Arnold
- Benjamin Auerbach
- Baird Respiratory Therapy, Inc.
- Jennifer Balsan
- Cathy Barson
- Linda R Barth
- Be Transformed Chiropractic, Inc
All providers in Glenside, PA · Orthodontics and Dentofacial Orthopedics Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2019. 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.