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General NPI Number Information
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NPI Number | 1629342530
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Entity Type | Individual
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Provider Name | NATHAN A MOELLER DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 211 E 20TH AVE
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City | TORRINGTON
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State | WY
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Zip | 82240
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Country | US
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Telephone | 307-886-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 211 E 20TH AVE
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City | TORRINGTON
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State | WY
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Zip | 82240-2813
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Country | US
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Telephone | 307-886-4300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10070
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License Number State | CO
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