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ETHAN D. MOULTON D.D.S.,M.S.
NPI 1740222579
Dentist - Periodontics in Idaho Falls, ID

Active since June 13, 2006
2375 E SUNNYSIDE RD STE I, IDAHO FALLS, ID 83404(208) 522-6683(208) 552-3085 Get Directions Write a Review

NPPES record last updated: September 16, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ethan D. Moulton D.d.s.,m.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN D. MOULTON D.D.S.,M.S. (NPI 1740222579) is an individual periodontics provider in Idaho Falls, Idaho, licensed in Idaho (D-4093-PE) and active in the NPI registry since June 2006.

NPPES Registry Identity

NPI1740222579
Entity TypeIndividualMale
Primary Taxonomy1223P0300X
Provider Legal NameETHAN D. MOULTONCredential: D.D.S.,M.S.
Location Address2375 E SUNNYSIDE RD STE IIdaho Falls, ID 83404-8281
Mailing Address2375 E Sunnyside Rd Ste IIdaho Falls, ID 83404-8281 · (208) 522-6683 · Fax (208) 552-3085
Phone(208) 522-6683
Fax(208) 552-3085
Sole ProprietorNo
Enumeration DateJune 13, 2006
Last NPPES UpdateSeptember 16, 2007
✔ NPI 1740222579 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in ID · D-4093-PE
Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Also ListedDentistTaxonomy 122300000X · License 5588 (OK)
2375 E SUNNYSIDE RD STE I, Idaho Falls, ID 83404
Open in Google Maps ↗

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NAGLAA BARGELSKI
Physician Assistant
2375 E SUNNYSIDE RD STE I
IDAHO FALLS, ID 83404
Bonneville County (208) 535-4300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Moulton's NPI number?

The NPI number for Ethan Moulton is 1740222579. It was assigned to this individual provider in the NPPES registry on June 13, 2006.

Where is Ethan Moulton located?

Ethan Moulton practices at 2375 E Sunnyside Rd Ste I, Idaho Falls, ID 83404. The listed phone number is (208) 522-6683.

What is Ethan Moulton's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Ethan Moulton was last updated on September 16, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.