1609157171 NPI number — DR. SHAHEEN M MOEZZI DDS

Table of content: DR. SHAHEEN M MOEZZI DDS (NPI 1609157171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609157171 NPI number — DR. SHAHEEN M MOEZZI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOEZZI
Provider First Name:
SHAHEEN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609157171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 E PRENTICE AVE STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-2990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-606-4220
Provider Business Mailing Address Fax Number:
720-606-4221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 W 44TH AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80212-7339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-421-0063
Provider Business Practice Location Address Fax Number:
720-907-1485
Provider Enumeration Date:
08/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0004X , with the licence number:  00202224 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 3121 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06678866 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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