Brett Eddis Mooso, D.D.S.,M.S.,P.A.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D-3029-OR Issued in ID

Practice address

1410 E 17TH St
Idaho Falls, ID 83404-6269

Phone

(208) 522-4552

Fax

(208) 522-4555

NPI assigned

Sep 15, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lowder Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Idaho, ID
  • NPI 1235390345
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1902902208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046269",
            "telephone_number": "208-522-4552",
            "fax_number": "208-522-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046269",
            "telephone_number": "208-522-4552",
            "fax_number": "208-522-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOSO",
        "first_name": "BRETT",
        "middle_name": "EDDIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,M.S.,P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D-3029-OR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "6083",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDE NUMBE",
            "identifier": "000010012359",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kailey Lynn Moore
• Megan Marie Moore, CCC-SLP
• Michael Kirk Moore Jr., M.D., P.C.
• Moose Creek Anesthesia PC
• Mooso Orthodontics
• Karla Jerica Mora-Cardona, BS
• Marian F. Morgan, LCSW EDS
• Ricky Morgan, DPT, ATC
• Stephanie Morgan, PA
• Elliot Morrell

• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.