Ronald Moos, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0445G Issued in WI

Practice address

130 N Fond Du Lac Ave
Campbellsport, WI 53010-0739

Phone

(920) 533-8512

NPI assigned

Jan 29, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Campbellsport Family Dentistry, LLC

  dba Campbellsport Family Dentistry

  • Dental Clinic/Center
  • Campbellsport, WI
  • NPI 1073368254
  NPD (past)

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972649952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 FRANCES AVENUE",
            "city": "CAMPBELLSPORT",
            "state": "WI",
            "postal_code": "530100739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 N FOND DU LAC AVE",
            "city": "CAMPBELLSPORT",
            "state": "WI",
            "postal_code": "530100739",
            "telephone_number": "920-533-8512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOS",
        "first_name": "RONALD",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "0445G",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heavenly Fit LLC
• Kimberly Ann Keceli, LAC, LMT, MSOM
• Shalbe Rae Kosciesza, RN
• David Anthony Krebs, D.C.
• Rebecca Ann Miller, LPN
• Gabrielle Murry, LPC
• Sarah Lee Peterson, RN
• Heather A Pfeifer, APNP
• Trisha Jo Pieper, RN
• Kimberly Lynne Potter, NURSE

• Dentist in Campbellsport, WI
• Providers in Campbellsport, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.