Ridge Crest Periodontics

LBN: Moulton Periodontics, Pllc
Ridge Crest Periodontics is an health care organization with primary practice located at 2375 E Sunnyside Rd Suite I, Idaho Falls ID 83404-8280. The organization recently has only one registered license in Ambulatory Health Care Facilities / Dental, which is considered as the primary health care specialty. Moulton Periodontics, Pllc can be contacted via phone (208) 522-6683, or through Moulton, Ethan D via phone (208) 522-6683.

Contact Information

Primary practice address
2375 E Sunnyside Rd Suite I Idaho Falls ID 83404-8280
Phone: (208) 522-6683
Fax: (208) 552-3085
Website:
Map and Directions
Authorized official contact:
Name: Moulton, Ethan D DDS MS
Phone: (208) 522-6683

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Dental 261QD0000X D-4093-PE Idaho

Profile Details

NPI number 1104085935
LBN Legal business name Moulton Periodontics, Pllc
DBA Doing business as Ridge Crest Periodontics
Authorized official Moulton, Ethan D DDS MS
Entity Organization
Organization subpart 1 No
Enumeration date Jun 6th, 2008
Last updated Jun 6th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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