Healthcare Provider Details

I. General information

NPI: 1609157171
Provider Name (Legal Business Name): SHAHEEN M MOEZZI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W 44TH AVE STE 200
DENVER CO
80212-7339
US

IV. Provider business mailing address

8301 E PRENTICE AVE STE 215
GREENWOOD VILLAGE CO
80111-2990
US

V. Phone/Fax

Practice location:
  • Phone: 303-421-0063
  • Fax: 720-907-1485
Mailing address:
  • Phone: 720-606-4220
  • Fax: 720-606-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number00202224
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: