1700312527 NPI number — DR. MICHAEL JAMES MOELLER D.D.S.

Table of content: DR. MICHAEL JAMES MOELLER D.D.S. (NPI 1700312527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700312527 NPI number — DR. MICHAEL JAMES MOELLER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOELLER
Provider First Name:
MICHAEL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700312527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WILMINGTON HOSPITAL DENTAL CLINIC
Provider Second Line Business Mailing Address:
501 WEST 14TH STREET
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-428-4850
Provider Business Mailing Address Fax Number:
302-320-4814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WILMINGTON HOSPITAL DENTAL CLINIC
Provider Second Line Business Practice Location Address:
501 WEST 14TH STREET
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-428-4850
Provider Business Practice Location Address Fax Number:
302-320-4814
Provider Enumeration Date:
05/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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