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
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-8281
- Phone
- (208) 522-6683
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
| Dentist - Periodontics — Periodontics |
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