MOULTON PERIODONTICS, PLLC (NPI# 1104085935) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104085935 |
| Entity Type | Organization |
| Organization Name | MOULTON PERIODONTICS, PLLC |
| Other Organization Name | RIDGE CREST PERIODONTICS |
| Practice Address |
2375 E Sunnyside Rd Suite I Idaho Falls ID 83404-8280 |
| Practice Telephone | 2085226683 |
| Practice Fax Number | 2085523085 |
| Mailing Telephone | 2085226683 |
| Mailing Fax Number | 2085523085 |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |
| Authorized Official Name | DR. ETHAN D MOULTON (OWNER) |
| Authorized Official Telephone | 2085226683 |
| Authorized Official Credential | DDS MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
D-4093-PE | ID | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Ridge Crest Periodontics | Doing Business As Name - Organization |
| Street Address |
2375 E SUNNYSIDE RD SUITE I |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-8280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740255264 | Jill Reid Weadick | Specialist | 2375 E Sunnyside Rd, Suite C, Idaho Falls, ID 83404-8280 | 2006-02-19 |
| 1962030627 | 3 Peaks Anesthesia, Inc | Nurse Anesthetist, Certified Registered | 2375 E Sunnyside Rd, Idaho Falls, ID 83404-8280 | 2020-03-30 |
| 1760720064 | Kierstin Nebeker | Nurse Practitioner | 2375 E Sunnyside Rd, Suite G, Idaho Falls, ID 83404-8280 | 2013-01-21 |
| 1033470216 | David Joseph Swope | Nurse Anesthetist, Certified Registered | 2375 E Sunnyside Rd, Suite B, Idaho Falls, ID 83404-8280 | 2012-06-04 |
| 1730440371 | Cheree Iadevaia | Specialist/Technologist | 2375 E Sunnyside Rd, Suite F, Idaho Falls, ID 83404-8280 | 2012-05-30 |
| 1295094217 | James Kendall Christensen | Family Medicine | 2375 E Sunnyside Rd, Ste F, Idaho Falls, ID 83404-8280 | 2012-05-11 |
| 1689955031 | Carrie Bean | Counselor | 2375 E Sunnyside Rd, Suite C, Idaho Falls, ID 83404-8280 | 2011-08-30 |
| 1063725083 | Pain Specialists of Idaho | Clinic/Center | 2375 E Sunnyside Rd, Suite 'j', Idaho Falls, ID 83404-8280 | 2010-07-19 |
| 1548594062 | Travis Lee Allen | Physician Assistant | 2375 E Sunnyside Rd, Suite J, Idaho Falls, ID 83404-8280 | 2009-09-30 |
| 1477798148 | Idaho Neurosurgical Center, Pa | Neurological Surgery | 2375 E Sunnyside Rd, Suite G, Idaho Falls, ID 83404-8280 | 2008-12-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275999872 | Broadway Smiles | Clinic/Center | 505 1st St Ste B, Idaho Falls, ID 83401-3929 | 2016-01-12 |
| 1659748903 | Boyle Family Dental | Clinic/Center | 1370 E 17th St, Idaho Falls, ID 83404-6270 | 2015-08-21 |
| 1780819516 | Willow Creek Dental PC | Clinic/Center | 1380 Latah Ave, Idaho Falls, ID 83402 | 2009-05-22 |
| 1346702461 | Brent Cline Dds Pllc | Clinic/Center | 749 Oxford Dr, Idaho Falls, ID 83401-4203 | 2019-04-05 |
| 1407355092 | Zimbi Dental Pllc | Clinic/Center | 1400 E 17th St, Idaho Falls, ID 83404-6269 | 2018-02-08 |
| 1508378647 | Bird Family Dental Idaho Falls, Pllc | Clinic/Center | 2960 Cortez Ave, Idaho Falls, ID 83404-7554 | 2017-10-30 |
| 1538596424 | Couch Dental Care | Clinic/Center | 2110 E 25th St, Idaho Falls, ID 83404-6475 | 2013-10-09 |
| 1669771069 | Atwood Family Dentistry | Clinic/Center | 1759 W Broadway St, Idaho Falls, ID 83402-3045 | 2011-03-24 |
| 1780904623 | Hoover Chartered | Clinic/Center | 1520 Elk Creek Dr, Idaho Falls, ID 83404-8322 | 2010-06-02 |
| 1679704647 | Comfort Care Dental of Idaho Falls, Pllc | Clinic/Center | 3550 Washington Pkwy, Idaho Falls, ID 83404-4968 | 2009-08-07 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
Please comment or provide details below to improve the information on MOULTON PERIODONTICS, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.