NPI age
19 years
Enumerated 2006-09-15
● Active
Type 1 · Individual
DR. Brett Eddis Mooso, D.D.S.,M.S.,P.A.
Mooso is 1 of 21 dentist providers in Idaho Falls and 1 of 135 in Idaho.
Primary specialty
Dentist
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2007-07-09
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 135 active dentist providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
State licenses
1 state
14% of peers hold multiple states
Subspecialties
0
17% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-09Enumerated in NPPES
2006
2026
Where they practice
Practice location
1410 E 17th St
Idaho Falls, ID 834046269
Mailing address
1410 E 17th St
Idaho Falls, ID 834046269
Specialties
-
Dentist PrimaryThat area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 6083 | BLUE CROSS PROVIDER NUMBE |
| 01 (ID) | 000010012359 | BLUE SHIELD PROVIDE NUMBE |
Practice context
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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