Organization · Type 2 NPI

Moulton Periodontics, PLLC

Dental Clinic/Center · Idaho Falls, ID

NPI number 1104085935 Active

Practice location

2375 E Sunnyside Rd, Suite I
Idaho Falls, ID 83404-8280

Call (208) 522-6683 Map

Fax (208) 552-3085

Specialties and licenses

TaxonomyCodeLicense
Dental Clinic/Center Primary 261QD0000XD-4093-PE (ID)

Dental Clinic/Center: Definition to come...

20 other providers at this address

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About NPI 1104085935

Moulton Periodontics, PLLC's National Provider Identifier is 1104085935, issued on Jun 6, 2008. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Idaho Falls, ID. The record was last updated on Jun 6, 2008.