Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ETHAN D. MOULTON, D.D.S.,M.S.
ActiveETHAN D. MOULTON, D.D.S.,M.S. is a Periodontology healthcare provider located in IDAHO FALLS, Idaho. NPI 1740222579 is currently active in the NPPES registry. Verify at CMS.
Periodontology · IDAHO FALLS, ID
Registration Details
- NPI Number
- 1740222579
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 13, 2006 (20.127698074783 yrs)
- Last Updated
- Sep 16, 2007
- Licenses
-
5588 (OK)D-4093-PE (ID)
Practice Information
- Address
-
2375 E SUNNYSIDE RD STE IIDAHO FALLS, ID, 834048281Browse ID providers · Browse ZIP 83404
- Phone
- 2085226683
- Fax
- 2085523085
- Primary Specialty
-
Periodontology
1223P0300X
- Additional Specialty
- Periodontology
Other Periodontology Providers in IDAHO FALLS, ID
| Name | Credential | NPI |
|---|---|---|
| JASON M PETERSON | DDS | 1225255748 |
| DR. RICHARD DUKE DAVIS | DMD | 1316670698 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.