ETHAN MOULTON, D.D.S.,M.S.

Dentist - Periodontics

Active Individual
NPI: 1740222579

Practice Address

2375 E SUNNYSIDE RD STE I
Idaho Falls, ID 83404

Phone: (208) 522-6683

Specialties

Specialty Code Primary License
Dentist 122300000X No 5588 (OK)
Dentist - Periodontics 1223P0300X Yes D-4093-PE (ID)

Frequently Asked Questions

NPI 1740222579 is the National Provider Identifier for ETHAN MOULTON, D.D.S.,M.S., a Dentist - Periodontics provider located in Idaho Falls, ID. This NPI was enumerated on June 13, 2006.
ETHAN MOULTON, D.D.S.,M.S. practices at 2375 E SUNNYSIDE RD STE I, Idaho Falls, ID 83404.

Quick Facts

NPI
1740222579
Type
Individual
Enumerated
Jun 13, 2006
Last Updated
Sep 16, 2007

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