Active NPI
Ryan Sean Moffett, D.M.D.
- Dentist
- Saint Paul, MN
National Provider Identifier
1215128350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D12882
- Practice address
- 409 Dunlap St N
Saint Paul, MN 55104-4201 - Phone
- (609) 420-3643
- NPI assigned
- Aug 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D12882 | MN | Primary |
Addresses
Primary practice location
409 Dunlap St N
Saint Paul, MN 55104-4201
Mailing address
1463 Maywood St
Saint Paul, MN 55117-3418
Phone (609) 420-3643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12882 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360195200000",
"number": "1215128350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1463 MAYWOOD ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551173418",
"telephone_number": "609-420-3643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 DUNLAP ST N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044201",
"telephone_number": "609-420-3643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFETT",
"first_name": "RYAN",
"middle_name": "SEAN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-05",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D12882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.