Provider Demographics
NPI:1386749554
Name:MOELLER, ROBERT JONATHAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JONATHAN
Last Name:MOELLER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7445
Mailing Address - Country:US
Mailing Address - Phone:785-404-1712
Mailing Address - Fax:
Practice Address - Street 1:1101 E. PRESCOTT AVE.
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-404-1712
Practice Address - Fax:785-404-1778
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606211223P0300X
OH30-0223591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty