Provider Demographics
NPI:1013354927
Name:SHAHROKH, POUYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:POUYAN
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 1:9608 E JEFFERSON PL
Mailing Address - Street 2:APT. 302
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4081
Mailing Address - Country:US
Mailing Address - Phone:856-383-7527
Mailing Address - Fax:
Practice Address - Street 1:301 W 6TH AVE
Practice Address - Street 2:MC0242
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5182
Practice Address - Country:US
Practice Address - Phone:303-602-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002023061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice