East Indianapolis Oral and Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

EAST INDIANAPOLIS ORAL AND MAXILLOFACIAL SURGERY

Doing business as

Steven C. Graham, DDS, Matthew C. Moll, DDS

Practice address

125 N Shortridge Rd
Indianapolis, IN 46219-4908

Phone

(317) 353-1320

Fax

(317) 359-5243

NPI assigned

Apr 17, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Matthew C Moll, DDSNPI 1689890030

Title

Owner

Phone

(317) 353-1320

Specialties & licenses 1

Addresses

Other names 1

• Steven C. Graham, DDS, Matthew C. Moll, DDS Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Charles Moll, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Indianapolis, IN
  • NPI 1689890030
  Authorized official Same address or phone

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942426341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N SHORTRIDGE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194908",
            "telephone_number": "317-353-1320",
            "fax_number": "317-359-5243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N SHORTRIDGE RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194908",
            "telephone_number": "317-353-1320",
            "fax_number": "317-359-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST INDIANAPOLIS ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOLL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-353-1320",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Steven C. Graham, DDS, Matthew C. Moll, DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.