Provider Demographics
NPI:1902816614
Name:MOELLING, STEPHEN ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ARTHUR
Last Name:MOELLING
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 1:15459 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3125
Mailing Address - Country:US
Mailing Address - Phone:636-391-8646
Mailing Address - Fax:636-391-3365
Practice Address - Street 1:15459 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3125
Practice Address - Country:US
Practice Address - Phone:636-391-8646
Practice Address - Fax:636-391-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice