NPI age
17 years
Enumerated 2008-06-06
● Active Type 2 · Organization
Moulton Periodontics, Pllc
Moulton Periodontics, Pllc is 1 of 202 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Moulton
Owner
Last NPPES update
2008-06-06
Source: monthly bulk 2026-05
How this organization compares
Across 202 active clinic/center providers in Idaho.
NPI age
17 years
↑ 9 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2008 → 2026
2008-06Enumerated in NPPES
2008
2026
Where they practice
Primary practice location
2375 E Sunnyside Rd, Suite I
Idaho Falls, ID 834048280
Mailing address
2375 E Sunnyside Rd, Suite I
Idaho Falls, ID 834048280
Authorized official
Ethan D Moulton, DDS MS
Owner
📞 2085226683
Individual providers at this organization
13 individual providers on file at this primary practice address.
- Travis Allen, PA-C Physician Assistant NPI 1548594062
- Joseph Anderson, PA-C Physician Assistant NPI 1386699833
- Carrie Bean, L.P.C. Counselor NPI 1689955031
- Maggi Bradley Pharmacist NPI 1083206353
- James Christensen, D.O. Family Medicine NPI 1295094217
- Gracie Hargraves, ED.D, LCPC Counselor NPI 1972654671
- Cheree Iadevaia, MS, LAT, ATC Specialist/Technologist NPI 1730440371
- Cathy Kotter, LPC Counselor NPI 1124184114
- Catherine Linderman, MD Clinic/Center NPI 1295836864
- Steveb Moody, LPC Counselor NPI 1467632323
- Russell Peterson, M.S. Counselor NPI 1093879637
- Jason Poston, MD Anesthesiology NPI 1457527772
- Alan Poulter, MD Anesthesiology NPI 1912046913
Specialties
-
Clinic/Center PrimaryDefinition to come...
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Ridge Crest Periodontics
Practice context
Multi-provider organization. 13 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.