Provider Demographics
NPI:1568906121
Name:ALTITUDE DENTISTRY PLLC
Entity Type:Organization
Organization Name:ALTITUDE DENTISTRY PLLC
Other - Org Name:ALTITUDE SPECIAL NEEDS AND PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOEZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-682-6789
Mailing Address - Street 1:3330 W 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3129
Mailing Address - Country:US
Mailing Address - Phone:602-391-8331
Mailing Address - Fax:
Practice Address - Street 1:5600 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7339
Practice Address - Country:US
Practice Address - Phone:602-391-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202224261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental