Provider Demographics
NPI:1609157171
Name:MOEZZI, SHAHEEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHEEN
Middle Name:M
Last Name:MOEZZI
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 1:8301 E PRENTICE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2990
Mailing Address - Country:US
Mailing Address - Phone:720-606-4220
Mailing Address - Fax:720-606-4221
Practice Address - Street 1:5600 W 44TH AVE STE 200
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:303-421-0063
Practice Address - Fax:720-907-1485
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002022241223D0004X
OH31211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06678866Medicaid