Individual provider · Type 1 NPI

Brett Eddis Mooso, DDS, M.S., P.A.

Orthodontics and Dentofacial Orthopedics Dentistry · Idaho Falls, ID

NPI number 1902902208 Active

Practice location

1410 E 17th St
Idaho Falls, ID 83404-6269

Fax (208) 522-4555

Specialties and licenses

Taxonomy	Code	License
Orthodontics and Dentofacial Orthopedics Dentistry Primary	1223X0400X	D-3029-OR (ID)

Orthodontics and Dentofacial Orthopedics Dentistry: That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of funct…

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About NPI 1902902208

Brett Eddis Mooso, DDS, M.S., P.A.'s National Provider Identifier is 1902902208, issued on Sep 15, 2006. The primary taxonomy on file is Orthodontics and Dentofacial Orthopedics Dentistry (1223X0400X), and the practice location is in Idaho Falls, ID. The record was last updated on Jul 9, 2007.