MOULTON PERIODONTICS, PLLC

IDAHO FALLS, ID
NPI1104085935
Entity TypeOrganization
Authorized ContactETHAN D MOULTON
Owner
208-522-6683
Organization Subpart ?No
Primary Taxonomy261QD0000X Clinic/Center Dental
(Licence: ID  D-4093-PE)
Enumeration Date2008-06-06
Last Update Date2008-06-06
Business Address
MOULTON PERIODONTICS, PLLC
2375 E SUNNYSIDE RD SUITE I
IDAHO FALLS, ID 83404-8280
Phone number: 208-522-6683
Mailing Address
MOULTON PERIODONTICS, PLLC
2375 E SUNNYSIDE RD SUITE I
IDAHO FALLS, ID 83404-8280
Phone number: 208-522-6683
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