DR. BRETT EDDIS MOOSO (NPI# 1902902208) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902902208 |
| Entity Type | Individual |
| Full Name | DR. BRETT EDDIS MOOSO |
| Credential | D.D.S.,M.S.,P.A. |
| Practice Address |
1410 E 17th St Idaho Falls ID 83404-6269 |
| Practice Telephone | 2085224552 |
| Practice Fax Number | 2085224555 |
| Mailing Telephone | 2085224552 |
| Mailing Fax Number | 2085224555 |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
D-3029-OR | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE SHIELD PROVIDE NUMBE | 000010012359 | 01 |
| ID | BLUE CROSS PROVIDER NUMBE | 6083 | 01 |
| Street Address |
1410 E 17TH ST |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-6269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285006403 | Evolution Chiropractic | Chiropractor | 1410 E 17th St, Idaho Falls, ID 83404-6269 | 2015-10-27 |
| 1386981900 | Jason Van Sickle | Chiropractor | 1410 E 17th St, Idaho Falls, ID 83404-6269 | 2013-01-16 |
| 1558692988 | Thomas R. Bench | Chiropractor | 1410 E 17th St, Idaho Falls, ID 83404-6269 | 2010-01-25 |
| 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 | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1194169649 | Jordan Rodney Hillam | Dentist | 758 E 65th S, Idaho Falls, ID 83404-7696 | 2013-04-25 |
| 1598053712 | Bret E. Mooso D.d.s.,m.s. | Dentist | 1580 Elk Creek Drive, Idaho Falls, ID 83404-6269 | 2011-07-21 |
| 1043441363 | Jared B Gill | Dentist | 3000 Pancheri Dr, Suite 1, Idaho Falls, ID 83402-5095 | 2009-08-04 |
| 1225289390 | Rodney H. Hillam | Dentist | 3325 S. Holmes Ave., Idaho Falls, ID 83404 | 2008-10-07 |
| 1306973862 | Rodney H Hillam Dds Ms Pa | Dentist | 3325 S Holmes Ave, Idaho Falls, ID 83404-7981 | 2007-02-28 |
| 1902949969 | Phillip David Lowder | Dentist | 250 South Skyine Drive, Ste 4, Idaho Falls, ID 83402 | 2007-02-15 |
| 1053496083 | Dwight Douglas Baker | Dentist | 1900 John Adams Pkwy, Idaho Falls, ID 83401-4366 | 2006-10-26 |
| 1740215870 | Elison Orthodontics Pllc | Dentist | 3357 Merlin Dr, Idaho Falls, ID 83404-7405 | 2006-07-11 |
| 1437684099 | Hillam Orthodontics Pa | Dentist | 3325 S. Holmes Ave., Idaho Falls, ID 83404 | 2017-04-20 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
Please comment or provide details below to improve the information on DR. BRETT EDDIS MOOSO.
| 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.