MEDICARE: DR. JAMES CARL MOELLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	13718	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457499972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES CARL MOELLER DDS

Provider Business Mailing Address
First Line	:	5445 SOUTHWYCK BLVD
Second Line	:	SUITE 105
City	:	TOLEDO
State	:	OH
Zip	:	43614-1534
Country	:	US
Telephone Number	:	419-865-1201
Fax Number	:	419-865-1061

Provider Business Practice Location Address
First Line	:	5445 SOUTHWYCK BLVD
Second Line	:	SUITE 105
City	:	TOLEDO
State	:	OH
Zip	:	43614-1534
Country	:	US
Telephone Number	:	419-865-1201
Fax Number	:	419-865-1061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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