Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 2901020373 | MI |
Y | 1223E0200X | Endodontist | 2901020373 | MI |
NPI | 1215220264 |
---|---|
Provider Name | Dr. Drew Moeller |
First Address | Commerce Township, MI 48382-3500 |
Second Address | Commerce Township, MI 48382-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 29/09/2015 |