Healthcare Provider Details

I. General information

NPI: 1861575268
Provider Name (Legal Business Name): KENNETH DRIZEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCAND DR
LOWELL MA
01852-1026
US

IV. Provider business mailing address

7 BELLE HAVEN DR
ANDOVER MA
01810-4253
US

V. Phone/Fax

Practice location:
  • Phone: 978-323-4399
  • Fax:
Mailing address:
  • Phone: 978-689-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10966
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: