Jeffrey Allen Moeller, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D11669 Issued in MN

Practice address

12389 Audrain Road 9931
Mexico, MO 65265-6260

Phone

(719) 251-4947

NPI assigned

Sep 15, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1932194099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12389 AUDRAIN ROAD 9931",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652656260",
            "telephone_number": "719-251-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12389 AUDRAIN ROAD 9931",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652656260",
            "telephone_number": "719-251-4947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOELLER",
        "first_name": "JEFFREY",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932194099",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mexico Surgical Associates, Inc
• Mexico Womens Health Specialists
• Mexico Womens Health Specialists LLC
• Missouri Central Physical Therapy, LLC (Mexico Physical Therapy)
• Missouri Veterans' Commission (Missouri Veterans' Home - Mexico)
• Karen Morrison
• Ahmad H Muraywid, M.D.
• Christopher P Murdock Jr., PHARM. D.
• Murphy Chiropractic Center-Mexico PC
• Myriam Ensling, M.D., LLC

• Dentist in Mexico, MO
• Providers in Mexico, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.