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General NPI Number Information
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NPI Number | 1538030903
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Entity Type | Organization
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Legal Business Name | MOOSO ORTHODONTICS
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 1580 ELK CREEK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8322
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Country | US
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Telephone | 208-522-4552
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Fax | 208-522-4555
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Provider Business Mailing Address
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Address Line | 1580 ELK CREEK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8322
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Country | US
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Telephone | 208-522-4552
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Fax | 208-522-4555
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA MARC MURPHY
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Credential | DMD
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Telephone | 208-339-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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