Sergio Mauricio Moeller Zevallos, DDS, MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

2901018235 Issued in MI

Practice address

2509 S State St
Ann Arbor, MI 48104-6145

Phone

(734) 662-7874

Fax

(734) 662-1518

NPI assigned

Sep 13, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mauricio Sergio Moeller Professional name

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Elan Lake Lansing

  • Dental Clinic/Center
  • East Lansing, MI
  • NPI 1811482565
  NPD
• Elan Okemos LLC

  • Dental Clinic/Center
  • Okemos, MI
  • NPI 1245803295
  NPD

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1790970663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2509 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481046145",
            "telephone_number": "734-662-7874",
            "fax_number": "734-662-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2509 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481046145",
            "telephone_number": "734-662-7874",
            "fax_number": "734-662-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOELLER ZEVALLOS",
        "first_name": "SERGIO",
        "middle_name": "MAURICIO",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-13",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901018235",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018235",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MI",
            "license": "2901018235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAURICIO",
            "last_name": "MOELLER",
            "middle_name": "SERGIO",
            "credential": "DDS, MS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Zubin Juzer Modi, MD
• Chanel Modock
• Lona Mody, MD
• Rajen J Mody, MB BS
• Swati Shah Mody, MD
• Claudia Moeller, LMSW
• Moeller, P.C.
• Robert Kenneth Moesta, MS, LLP
• Seth B Moffatt, MD
• Abigail Moffett

• Prosthodontics in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Prosthodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; 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.