Individual provider Active NPI

Marlen Robles-Moreno, DDS, CAGS, MSD

  • Prosthodontics
  • Augusta, GA
National Provider Identifier
1245749290
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
DNF000411 Issued in GA
Practice address
1430 John Wesley Gilbert Drive
Augusta, GA 30912-0001
Phone
(706) 721-2371
Fax
(706) 721-6778
NPI assigned
Sep 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 39184 TX
Prosthodontics 1223P0700X DNF000411 GA Primary

Addresses

Primary practice location

1430 John Wesley Gilbert Drive
Augusta, GA 30912-0001

Mailing address

1430 John Wesley Gilbert Drive GC-1012
Augusta, GA 30912-0004
Phone (706) 721-2371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250313003591 GA Order and Referring Only - ProsthodonticsPractitioner - Prosthodontics 3577085034

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39184TXMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Au Dental Associates Dentist CurrentSince Apr 16, 2023 Accepting new patients
Au Surgery Center, LLC CurrentSince Mar 16, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mroblesmoreno61640@direct.utmsa.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1245749290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE GC-1012",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-721-2371",
            "fax_number": "706-721-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120001",
            "telephone_number": "706-721-2371",
            "fax_number": "706-721-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBLES-MORENO",
        "first_name": "MARLEN",
        "name_prefix": "Dr.",
        "credential": "DDS, CAGS, MSD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "TX",
            "license": "39184",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "GA",
            "license": "DNF000411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.