Ethan D. Moulton, D.D.S.,M.S.

NPI #1740222579 in Idaho Falls, Idaho

Provider Information

NPI Number
1740222579
Entity Type
Individual
Name
Ethan D. Moulton, D.D.S.,M.S.
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Dentist - Periodontics
Credential
D.D.S.,M.S.
Enumeration Date
Jun 13, 2006
Last Updated
Sep 16, 2007

Practice Location

Address
2375 E SUNNYSIDE RD STE I
State
Idaho
ZIP Code
83404-8281
Phone
(208) 522-6683

Specialties & Taxonomy Codes

Specialty
Dentist
Dentist - PeriodonticsPeriodontics

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