Organization
SUNNYSIDE DENTAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN O JOHNSON D.M.D. (PRESIDENT)
(208) 522-8854
Entity
Organization
Contact information
Practice address
1520 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
(208) 522-8854
Mailing address
1520 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
(208) 522-8854
(208) 535-0551
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1853
ID
Other
Enumeration date
12/01/2009
Last updated
05/20/2015
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