DR. MARK STEVEN MOELLER (NPI# 1083895510) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083895510 |
| Entity Type | Individual |
| Full Name | DR. MARK STEVEN MOELLER |
| Credential | DDS |
| Practice Address |
1836 South Ave La Crosse WI 54601-5429 |
| Practice Telephone | 6087827300 |
| Mailing Telephone | 6087827300 |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2018-12-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 1001156 | WI | Dental Providers |
| N | 122300000X | Dentist | 09067 | IA | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
1001156 | WI | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
S25 | MN | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457508608 | Mark Moeller | Family Medicine | 2020 Sutter Pl, Suite 101, Davis, CA 95616-6213 | 2008-08-19 |
| 1053590133 | Mark S Moeller | Psychiatry & Neurology | 6300 West Loop S, Suite 680, Bellaire, TX 77401-2900 | 2007-10-25 |
| 1194870592 | Mark R Moeller | Physical Therapist | 2015 Sidewinder Dr, Park City, UT 84060-7323 | 2007-01-24 |
| 1336126416 | Mark Steven Moeller | Emergency Medicine | 1100 Balsam Ave, Boulder, CO 80304-3404 | 2005-12-29 |
| 1053304097 | Mark B Moeller | Internal Medicine | 137 Medical Lane, Pollocksville, NC 28573 | 2005-08-24 |
| Street Address |
1836 SOUTH AVE |
| City | LA CROSSE |
| State | WI |
| Zip Code | 54601-5429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952304834 | Susan G Maclellan-tobert | Pediatrics | 1836 South Ave, La Crosse, WI 54601-5429 | 2005-05-24 |
| 1861099590 | Ellen Compton | Dietitian, Registered | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-10-06 |
| 1699382630 | Jedd Sebion | Pharmacist | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-09-24 |
| 1104436351 | Taryn Jean Simon | Speech-Language Pathologist | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-08-03 |
| 1497376438 | Eva Igler | Student in an Organized Health Care Education/Training Program | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-04-30 |
| 1568083608 | Benjamin Haase Thompson | Student in an Organized Health Care Education/Training Program | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-04-29 |
| 1316568736 | Eric Bobel | Student in an Organized Health Care Education/Training Program | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-04-27 |
| 1134749708 | Kristin Danielle Heslep | Student in an Organized Health Care Education/Training Program | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-04-23 |
| 1982224598 | Rebecca Stanek | Student in an Organized Health Care Education/Training Program | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-04-23 |
| 1609496595 | Marie Gilberte Cineus | Student in an Organized Health Care Education/Training Program | 1836 South Ave, La Crosse, WI 54601-5429 | 2020-04-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891324265 | Meagan Mcrae | Student in an Organized Health Care Education/Training Program | 1725 State St., 4051 Health Science Center, La Crosse, WI 54601 | 2020-04-07 |
| 1255969671 | Erin Dingman | Student in an Organized Health Care Education/Training Program | 1751 State Street, 4051 Health Science Center, La Crosse, WI 54601 | 2020-03-31 |
| 1619505047 | Nicole Kay Lynch | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State St, La Crosse, WI 54601 | 2020-03-31 |
| 1174151757 | Jenna Sells | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1740818301 | Katie Irene Tahtinen | Student in an Organized Health Care Education/Training Program | Uwl- 4051 Health Science Center, 1725 State St., La Crosse, WI 54601 | 2020-03-30 |
| 1932737517 | Margaret May Grimm | Student in an Organized Health Care Education/Training Program | Univesity of Wisconsin-la Crosse, 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1831727312 | Matthew Timothy Axler | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1093340473 | Denise Stinson | Technician | 1311 Badger St, Apt 505, La Crosse, WI 54601 | 2020-03-06 |
| 1922632397 | Ibrahim Ahsan | Pharmacist | 1105 Wi-16, La Crosse, WI 54601 | 2020-02-25 |
| 1750913356 | Liza R Collins | Massage Therapist | 1415 State Wi 16, La Crosse, WI 54601 | 2020-02-11 |
| Find all providers in zip 54601 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942470331 | John Shea D.d.s. LLC | Dentist | 615 10th St S, La Crosse, WI 54601-4768 | 2008-03-03 |
| 1679662324 | John H. Betz | Dentist | 615 10th St S, La Crosse, WI 54601-4768 | 2006-10-12 |
| 1881690170 | Michael P Funk | Dentist | 1836 South Ave, La Crosse, WI 54601-5429 | 2005-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508478454 | New Richmond Kidds Pediatric Dentistry LLC | Dentist | 1244 N 4th St Ste 300, New Richmond, WI 54017-7540 | 2020-08-21 |
| 1710509484 | Hospital Dentistry for Kids Inc. | Dentist | 4980 S County Rd T, Denmark, WI 54208 | 2020-05-15 |
| 1467808592 | Alexis Colosimo | Dentist | 11035 W Forest Home Ave Ste 116, Hales Corners, WI 53130-2541 | 2016-05-07 |
| 1649676032 | Matina Angelopoulou | Dentist | 1801 West Winsconsin Ave, Milwaukee, WI 53233 | 2014-11-12 |
| 1407257108 | The Kids Dentist LLC | Dentist | 10618 N Port Washington Rd, Mequon, WI 53092-5013 | 2014-09-12 |
| 1144631698 | Jennifer Sinnen | Dentist | 14430 W Greenfield Ave, Brookfield, WI 53005-7036 | 2014-05-17 |
| 1346667045 | David Howard Jadin | Dentist | 1245 Main St, Green Bay, WI 54302 | 2014-03-20 |
| 1396184370 | Adam Joseph Pamer | Dentist | 1320 S Green Bay Rd, Mt Pleasant, WI 53406-4406 | 2013-06-23 |
| 1255628491 | Ronald J Pruhs | Dentist | 4120 S Lake Dr, Apt. 251, Saint Francis, WI 53235-5954 | 2011-07-08 |
| 1982906525 | Jennifer Chun | Dentist | 100 River Pl Ste 110, Monona, WI 53716 | 2010-12-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.