Brent Jeffrey Moeggenborg, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D18900 Issued in MI

Practice address

226 N State Street
Alma, MI 48801

Phone

(989) 463-5392

Fax

(989) 463-3973

NPI assigned

Feb 12, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 16, 2015 through Dec 16, 2027

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.

• Wassenaar Frutiger Wassenaar DDS PC

  • Dentist
  • Alma, MI
  • NPI 1992764443
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700928215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 N STATE STREET",
            "city": "ALMA",
            "state": "MI",
            "postal_code": "48801",
            "telephone_number": "989-463-5392",
            "fax_number": "989-463-3973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 N STATE STREET",
            "city": "ALMA",
            "state": "MI",
            "postal_code": "48801",
            "telephone_number": "989-463-5392",
            "fax_number": "989-463-3973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEGGENBORG",
        "first_name": "BRENT",
        "middle_name": "JEFFREY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "D18900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brookelyn Marie Miller, AT, ATC
• Shaelyn Miller, FNP-C
• Molly A Minnick, LMSW
• Miriam B. Adam Services LLC
• Jessica Bea Mitchell
• Sarah Moffett
• Nathaniel Robert Mogg
• Sudeep Mohan, M.D.
• Monaco Management, LLC
• Ella Mondroski

• Dentist in Alma, MI
• Providers in Alma, MI by specialty
• Dentist in Michigan

• 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.