Provider Demographics
NPI:1861575268
Name:DRIZEN, KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:DRIZEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BELLE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4253
Mailing Address - Country:US
Mailing Address - Phone:978-689-8337
Mailing Address - Fax:
Practice Address - Street 1:75 ARCAND DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1026
Practice Address - Country:US
Practice Address - Phone:978-323-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA109661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics