Provider Demographics
NPI:1417911561
Name:BRAZIEL, BENJAMIN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:BRAZIEL
Suffix:III
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 1:124 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1811
Mailing Address - Country:US
Mailing Address - Phone:310-671-7112
Mailing Address - Fax:310-671-7041
Practice Address - Street 1:124 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1811
Practice Address - Country:US
Practice Address - Phone:310-671-7112
Practice Address - Fax:310-671-7041
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB350741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice