Active NPI
Matthew T Moberg, DDS
- General Practice Dentistry
- Jbsa - Lackland, TX
National Provider Identifier
1851532980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901020027
- Practice address
- 1100 Wilford Hall Loop BLDG 4554
Jbsa - Lackland, TX 78236-5638 - Phone
- (210) 808-1111
- NPI assigned
- Mar 19, 2009
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901020027 | MI | Primary |
Addresses
Primary practice location
1100 Wilford Hall Loop BLDG 4554
Jbsa - Lackland, TX 78236-5638
Mailing address
1100 Wilford Hall Loop BLDG 4554
Jbsa - Lackland, TX 78236-5638
Phone (210) 808-1111
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901020027 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692316800000",
"number": "1851532980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP BLDG 4554",
"city": "JBSA - LACKLAND",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-808-1111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP BLDG 4554",
"city": "JBSA - LACKLAND",
"state": "TX",
"postal_code": "782365638",
"telephone_number": "210-808-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOBERG",
"first_name": "MATTHEW",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-19",
"last_updated": "2023-08-18",
"certification_date": "2023-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901020027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbsa - Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.