Provider Demographics
NPI:1750353397
Name:RAZIEL, AHRON (DDS)
Entity type:Individual
Prefix:DR
First Name:AHRON
Middle Name:
Last Name:RAZIEL
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 1:3915 AVENUE V
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5156
Mailing Address - Country:US
Mailing Address - Phone:718-338-4800
Mailing Address - Fax:718-338-0487
Practice Address - Street 1:3915 AVENUE V, #204
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5156
Practice Address - Country:US
Practice Address - Phone:718-338-4800
Practice Address - Fax:718-338-0487
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0386841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02496248Medicaid