Individual
KONSTANTIN V AMIRZADOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
133 MARKET STREET, LOWELL, MA 01852
(978) 458-1179
(978) 805-1415
Mailing address
133 MARKET STREET, LOWELL, MA 01852
(978) 458-1179
(978) 805-1415
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18197
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2752307
—
MA
01
—
X11615
BLUE CROSS BLUE SHIELD
MA
Enumeration date
02/26/2007
Last updated
07/08/2007
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