Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Moulton Periodontics, PLLC

Organization Dental Clinic/Center · NPI 1104085935

Moulton Periodontics, PLLC is a Dental Clinic/Center in Idaho Falls, Idaho. Licensed in Idaho. Registered with an NPI since 2008.

Licensed in
ID
In the registry since
2008
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2375 E Sunnyside Rd Ste I
Idaho Falls, ID 83404-8280
Phone: (208) 522-6683
Fax: (208) 552-3085
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X · Licence D-4093-PE (ID)

Record details

NPI number1104085935
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ethan Moulton — Owner · (208) 522-6683
Other names Ridge Crest Periodontics
NPI enumeratedJune 6, 2008
Last updated in NPPESJune 6, 2008
Mailing address2375 E Sunnyside Rd, Suite I, Idaho Falls, ID 83404-8280

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