| NPI | 1104085935 |
|---|---|
| Doing Business As | RIDGE CREST PERIODONTICS |
| Entity Type | Organization |
| Authorized Contact | ETHAN D MOULTON Owner 208-522-6683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D-4093-PE) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |