NPI 1003144114

Sunnyside Dental Care PC

Organisation General Practice Dentistry Idaho Falls, ID

Practice location

Address: 1520 Elk Creek Dr, Idaho Falls, ID 83404-8322
Phone: (208) 522-8854

Authorised official

Name: Evan O Johnson
Title: President
Phone: (208) 522-8854

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence D1853 (ID)

Other Dentist providers in Idaho →

Registry record

NPI: 1003144114
Entity type: Organization
NPI issued: 1 Dec 2009
Record last updated: 20 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.