MEDICARE: DR. MATTHEW CHARLES MOELLER D.D.S.

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	1223G0001X	General Practice Dentistry	12008713	IN

General Provider Information

NPI Number	:	1659375319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW CHARLES MOELLER D.D.S.

Provider Business Mailing Address
First Line	:	7854 CLEARWATER COVE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-4900
Country	:	US
Telephone Number	:	317-679-0343
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 N MERIDIAN ST
Second Line	:	STE 1D
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-4044
Country	:	US
Telephone Number	:	317-679-0343
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2007

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