Moulton, Ethan D.

Moulton, Ethan D. is an individual health care provider with primary practice located at 2375 E Sunnyside Rd Ste I , Idaho Falls ID 83404-8281. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Periodontics. Dental Providers / Periodontics is his primary health care specialty. Moulton, Ethan D. can be contacted via phone (208) 522-6683.

Contact Information

Primary practice address
2375 E Sunnyside Rd Ste I Idaho Falls ID 83404-8281
Phone: (208) 522-6683
Fax: (208) 552-3085
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 5588 Oklahoma
Dental Providers / Periodontics 1223P0300X D-4093-PE Idaho

Profile Details

NPI number 1740222579
LBN Legal business name Moulton, Ethan D.
Credentials D.D.S.,M.S.
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Sep 16th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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