Moulton Periodontics, Pllc
NPI #1104085935 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1104085935
- Entity Type
- Organization
- Organization Name
- Moulton Periodontics, Pllc
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Jun 6, 2008
- Last Updated
- Jun 6, 2008
Practice Location
- Address
- 2375 E SUNNYSIDE RD
- Address 2
- SUITE I
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-8280
- Phone
- (208) 522-6683
Authorized Official
- Name
- DR. ETHAN D MOULTON, DDS MS
- Title
- OWNER
- Phone
- (208) 522-6683
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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