Active NPI
Kathleen M Moen, DDS
- Dentist
- Avon, MN
National Provider Identifier
1891785226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10962
- Practice address
- 300 Avon Ave S
Suite F
Avon, MN 56310-8516 - Phone
- (320) 356-7374
- Fax
- (320) 356-9427
- NPI assigned
- Oct 26, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10962 | MN | Primary |
Addresses
Primary practice location
300 Avon Ave S
Suite F
Avon, MN 56310-8516
Mailing address
PO Box 181
Avon, MN 56310-0181
Phone (320) 356-7374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150511001488 | MN | Order and Referring Only - General Practice | 3678892866 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10962 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196035200000",
"number": "1891785226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 181",
"city": "AVON",
"state": "MN",
"postal_code": "563100181",
"telephone_number": "320-356-7374",
"fax_number": "320-356-9427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 AVON AVE S",
"address_2": "SUITE F",
"city": "AVON",
"state": "MN",
"postal_code": "563108516",
"telephone_number": "320-356-7374",
"fax_number": "320-356-9427"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOEN",
"first_name": "KATHLEEN",
"middle_name": "M",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-26",
"last_updated": "2007-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "10962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avon, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.