RIDGE CREST PERIODONTICS
NPI 1104085935
Clinic/Center - Dental in Idaho Falls, ID
Active since June 06, 2008
2375 E SUNNYSIDE RD, SUITE I, IDAHO FALLS, ID 83404(208) 522-6683(208) 552-3085 Get Directions Write a Review
About Ridge Crest Periodontics NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RIDGE CREST PERIODONTICS (NPI 1104085935) is a healthcare organization registered as a dental in Idaho Falls, Idaho and active in the NPI registry since June 2008. The organization lists Ethan D Moulton, Owner, as its authorized official.
NPPES Registry Identity
NPI1104085935
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameMOULTON PERIODONTICS, PLLC
Location Address2375 E SUNNYSIDE RD, SUITE IIdaho Falls, ID 83404-8280
Mailing Address2375 E Sunnyside Rd, Suite IIdaho Falls, ID 83404-8280 · (208) 522-6683 · Fax (208) 552-3085
Phone(208) 522-6683
Fax(208) 552-3085
Organization SubpartNo
Authorized OfficialEthan D MoultonOwner · (208) 522-6683
Enumeration DateJune 6, 2008
✔ NPI 1104085935 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
License✔ Licensed in ID · D-4093-PE
2375 E SUNNYSIDE RD, Idaho Falls, ID 83404
Other Names 1
Doing Business AsRidge Crest Periodontics
Other Providers at the Same Location NPPES 19
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Clinic/Center (Pain)
2375 E SUNNYSIDE RD, SUITE A
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
Clinic/Center (Ambulatory Surgical)
2375 E SUNNYSIDE RD, SUITE B
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
Counselor (Mental Health)
2375 E SUNNYSIDE RD, SUITE C
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
Counselor (Mental Health)
2375 E SUNNYSIDE RD, SUITE C
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104085935, enumerated as an "organization" on June 06, 2008.
The provider is located at 2375 E SUNNYSIDE RD SUITE I IDAHO FALLS, ID 83404 and the phone number is (208) 522-6683.
Clinic/Center with taxonomy code 261QD0000X and a focus in Dental.
