Active NPI
William Gardner Moll, D.D.S.
- Oral & Maxillofacial Surgery (D.M.D.)
- Schererville, IN
National Provider Identifier
1558789891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)
- License
- 12012169A
- Practice address
- 601 W US Highway 30
Schererville, IN 46375-2656 - Phone
- (219) 322-0501
- NPI assigned
- Apr 3, 2014
- Last updated
- Nov 26, 2019
- 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 |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 12012169A | IN | Primary |
Addresses
Primary practice location
601 W US Highway 30
Schererville, IN 46375-2656
Mailing address
601 W US Highway 30
Schererville, IN 46375-2656
Phone (219) 322-0501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151106001489 | IL | Order and Referring Only - Oral Surgery | 1052621851 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012169A | IN | MD | Oral & Maxillofacial Surgery (D.M.D.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574726400000",
"number": "1558789891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 W US HIGHWAY 30",
"city": "SCHERERVILLE",
"state": "IN",
"postal_code": "463752656",
"telephone_number": "219-322-0501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 W US HIGHWAY 30",
"city": "SCHERERVILLE",
"state": "IN",
"postal_code": "463752656",
"telephone_number": "219-322-0501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLL",
"first_name": "WILLIAM",
"middle_name": "GARDNER",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-03",
"last_updated": "2019-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "IN",
"license": "12012169A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schererville, IN
- Midwest Clinic PC
- Midwest Express Care, Inc (Midwest Express Clinic)
- Midwest Express Care, Inc
- Midwest Healthcare Services PC
- Elaine Criselda Dequina Moline, PT
- Monzel Chiropractic LLC
- Elizabeth Ann Mora, OTR
- Laura B Mora, O.T.
- Motus Integrative Health, PC (Motus Integrative Health)
- Kelly P Mucha, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.