Provider Demographics
NPI:1124533328
Name:ROYAL FALCONS LLC
Entity type:Organization
Organization Name:ROYAL FALCONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-682-6789
Mailing Address - Street 1:5600 W 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7339
Mailing Address - Country:US
Mailing Address - Phone:702-682-6789
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:702-682-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-10
Last Update Date:2017-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1609157171Medicaid