Active NPI
Matthew James Moen, DDS
- Dentist
- Hugo, MN
National Provider Identifier
1952143109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D15093
- Practice address
- 14741 Victor Hugo Blvd N
Hugo, MN 55038-4561 - Phone
- (651) 407-0999
- NPI assigned
- Jun 10, 2024
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D15093 | MN | Primary |
Addresses
Primary practice location
14741 Victor Hugo Blvd N
Hugo, MN 55038-4561
Mailing address
18753 Melrose Chase
Eden Prairie, MN 55347-3483
Phone (612) 590-6448
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 |
|---|---|---|---|
| D15093 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PDG, P.a. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Hugo, MN
- NPI 1346679859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717977600000",
"number": "1952143109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18753 MELROSE CHASE",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553473483",
"telephone_number": "612-590-6448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14741 VICTOR HUGO BLVD N",
"city": "HUGO",
"state": "MN",
"postal_code": "550384561",
"telephone_number": "651-407-0999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOEN",
"first_name": "MATTHEW",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-10",
"last_updated": "2024-06-10",
"certification_date": "2024-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D15093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hugo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.