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Individual

DR. KHOSROW BENJAMIN AZIZI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
242 N KESWICK AVE, GLENSIDE, PA 19038-4804
(215) 576-6414
(215) 576-8497
Mailing address
242 N KESWICK AVE, GLENSIDE, PA 19038-4804
(215) 576-6414
(215) 576-8497

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS025908L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
505604
UNITED CONCORDIA ID NUMBE
PA
Enumeration date
01/12/2007
Last updated
12/17/2019
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