# SUNNYSIDE DENTAL CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003144114
- **Authorized official:** EVAN O JOHNSON D.M.D. (PRESIDENT)
- **Authorized official phone:** (208) 522-8854

## Contact information

- **Practice address:** 1520 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
- **Practice address phone:** (208) 522-8854
- **Mailing address:** 1520 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
- **Mailing address phone:** (208) 522-8854
- **Mailing address fax:** (208) 535-0551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1853 | ID | Yes |

## Other

- **Enumeration date:** 12/01/2009
- **Last updated:** 05/20/2015