OrganizationActive
Moulton Periodontics, PLLC
NPI 1104085935 · Dental Clinic/Center · Idaho Falls, ID
Moulton Periodontics, PLLC is a Dental Clinic/Center organization in Idaho Falls, ID (NPI 1104085935).
Provider details
- NPI number
- 1104085935
- Entity type
- Organization
- Primary specialty
- Dental Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Ethan Moulton, Owner(208) 522-6683
- License
- D-4093-PE (ID)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2375 E Sunnyside Rd
Suite I
Idaho Falls, ID 83404-8280
Phone: (208) 522-6683
Fax: (208) 552-3085
Street-level locationGet directions
Mailing address
2375 E Sunnyside Rd
Idaho Falls, ID 83404-8280
Other names (DBA / former)
- Doing business as
- Ridge Crest Periodontics
Registry dates
- Enumerated
- 2008-06-06
- Last updated
- 2008-06-06
Frequently asked questions
- What is Moulton Periodontics, PLLC's NPI number?
- Moulton Periodontics, PLLC's National Provider Identifier (NPI) is 1104085935, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Moulton Periodontics, PLLC?
- Moulton Periodontics, PLLC is classified in the NPPES registry as Dental Clinic/Center (Ambulatory Health Care Facilities).
- Where is Moulton Periodontics, PLLC located?
- Moulton Periodontics, PLLC's practice location on file with NPPES is 2375 E Sunnyside Rd, Idaho Falls, ID 83404-8280.
- What is Moulton Periodontics, PLLC's phone number?
- The practice phone number listed in the NPPES registry for Moulton Periodontics, PLLC is (208) 522-6683.
- Who is the authorized official for Moulton Periodontics, PLLC?
- The authorized official listed on Moulton Periodontics, PLLC's NPPES record is Ethan Moulton, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Moulton Periodontics, PLLC's NPI active?
- Yes — Moulton Periodontics, PLLC's NPI (1104085935) is active in the NPPES registry as of the last update on 2008-06-06.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.