Rolf P Moen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9531 Issued in MN

Practice address

402 James Street
Brainerd, MN 56401-2965

Phone

(218) 829-4243

Fax

(218) 825-8102

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Lake County Dental LTD

  • Dentist
  • Brainerd, MN
  • NPI 1558361667
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275696387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 JAMES STREET",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012965",
            "telephone_number": "218-829-4243",
            "fax_number": "218-825-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 JAMES STREET",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012965",
            "telephone_number": "218-829-4243",
            "fax_number": "218-825-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEN",
        "first_name": "ROLF",
        "middle_name": "P",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "9531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05220700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Minnesota Specialty Health Systems-Brainerd
• Minnesota State Colleges and Universities (Central Lakes College)
• Minnesota Teen Challenge, Inc
• Minnesota Teen Challnge, Inc. (Minnesota Adult and Teen Challenge- Life renewal)
• Mjheldt Inc (Jefferson Hearing Aid Center)
• Matthew Gary Mohrenweiser, CRNA
• Michael Monda, OD
• Steven Todd Monda, O.D.
• Dustin R Monson, LMFT
• Jane Terese Monson, LICSW

• Dentist in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.