Mooso, Brett Eddis
Mooso, Brett Eddis is an sole proprietor health care provider with primary practice located at 1410 E 17Th St , Idaho Falls ID 83404-6269. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Mooso, Brett Eddis can be contacted via phone (208) 522-4552.Contact Information
Primary practice address
1410 E 17Th St
Idaho Falls ID 83404-6269
Phone: (208) 522-4552
Fax: (208) 522-4555
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Orthodontics and Dentofacial Orthopedics | 1223X0400X | D-3029-OR | Idaho |
Profile Details
| NPI number | 1902902208 |
|---|---|
| LBN Legal business name | Mooso, Brett Eddis |
| Credentials | D.D.S.,M.S.,P.A. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 15th, 2006 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902902208 | NPPES |
| Idaho | Other | 6083 | BLUE CROSS PROVIDER NUMBE |
| Idaho | Other | 000010012359 | BLUE CROSS PROVIDER NUMBE |
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