Individual provider · Type 1 NPI
Ethan D. Moulton, DDS, M.S.
Periodontics · Idaho Falls, ID
NPI number
1740222579
Active
Practice location
2375 E Sunnyside Rd Ste I
Idaho Falls, ID 83404-8281
Fax (208) 552-3085
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | 5588 (OK) |
| Periodontics Primary | 1223P0300X | D-4093-PE (ID) |
Periodontics: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
Another provider at this address
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About NPI 1740222579
Ethan D. Moulton, DDS, M.S.'s National Provider Identifier is 1740222579, issued on Jun 13, 2006. The primary taxonomy on file is Periodontics (1223P0300X), and the practice location is in Idaho Falls, ID. The record was last updated on Sep 16, 2007.