Active NPI
Robert Jonathan Moeller, DDS, MS
- Periodontics
- Salina, KS
National Provider Identifier
1386749554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 60621
- Practice address
- 1101 E. Prescott Ave.
Salina, KS 67401 - Phone
- (785) 404-1712
- Fax
- (785) 404-1778
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 60621 | KS | Primary |
Addresses
Primary practice location
1101 E. Prescott Ave.
Salina, KS 67401
Mailing address
1011 E Prescott Rd
Salina, KS 67401-7445
Phone (785) 404-1712
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60621 | KS | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589241600000",
"number": "1386749554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 E PRESCOTT RD",
"city": "SALINA",
"state": "KS",
"postal_code": "674017445",
"telephone_number": "785-404-1712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 E. PRESCOTT AVE.",
"city": "SALINA",
"state": "KS",
"postal_code": "67401",
"telephone_number": "785-404-1712",
"fax_number": "785-404-1778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOELLER",
"first_name": "ROBERT",
"middle_name": "JONATHAN",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2020-05-12",
"certification_date": "2020-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Periodontics",
"state": "KS",
"license": "60621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salina, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.