Healthcare Provider Details

I. General information

NPI: 1538030903
Provider Name (Legal Business Name): MOOSO ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

IV. Provider business mailing address

1580 ELK CREEK DR
IDAHO FALLS ID
83404-8322
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-4552
  • Fax: 208-522-4555
Mailing address:
  • Phone: 208-522-4552
  • Fax: 208-522-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA MARC MURPHY
Title or Position: OWNER
Credential: DMD
Phone: 208-339-4468