Provider Demographics
NPI:1447796487
Name:SOLTANI BOZCHALOEI, SHABNAM (DDS)
Entity Type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:SOLTANI BOZCHALOEI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 S WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5107
Mailing Address - Country:US
Mailing Address - Phone:617-866-9664
Mailing Address - Fax:
Practice Address - Street 1:6008 S WILLOW WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5107
Practice Address - Country:US
Practice Address - Phone:617-866-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist