Provider Demographics
NPI:1922312529
Name:SHAHROKH, BABAK (DMD)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:SHAHROKH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14251 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8706
Mailing Address - Country:US
Mailing Address - Phone:303-343-3133
Mailing Address - Fax:
Practice Address - Street 1:1257 ARMORLITE DR APT 308
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1375
Practice Address - Country:US
Practice Address - Phone:760-471-9560
Practice Address - Fax:303-343-3139
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA641451223G0001X
CO10577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO60906774Medicaid