Provider Demographics
NPI:1215220264
Name:MOELLER, DREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:
Last Name:MOELLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 UNION LAKE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3500
Mailing Address - Country:US
Mailing Address - Phone:248-363-9345
Mailing Address - Fax:
Practice Address - Street 1:2900 UNION LAKE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3500
Practice Address - Country:US
Practice Address - Phone:248-363-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010203731223E0200X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223D0001XDental ProvidersDentistDental Public Health