Individual
EVAN O JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1520 ELK CRK, IDAHO FALLS, ID 83404-8322
(208) 522-8854
(208) 535-0551
Mailing address
1520 ELK CRK, 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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001263500
—
ID
Enumeration date
03/31/2006
Last updated
05/19/2015
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