| Sunnyside Dental Care Pc | |
|
1520 Elk Creek Dr Idaho Falls ID 83404-8322 | |
| (208) 522-8854 | |
| Not Available |
| Full Name | Sunnyside Dental Care Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1520 Elk Creek Dr, Idaho Falls, Idaho |
| Authorized Official Name and Position | Evan O Johnson (PRESIDENT) |
| Authorized Official Contact | 2085228854 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunnyside Dental Care Pc 1520 Elk Creek Dr Idaho Falls ID 83404-8322 Ph: (208) 522-8854 | Sunnyside Dental Care Pc 1520 Elk Creek Dr Idaho Falls ID 83404-8322 Ph: (208) 522-8854 |
| NPI Number | 1003144114 |
|---|---|
| Provider Enumeration Date | 12/01/2009 |
| Last Update Date | 05/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003144114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D1853 (Idaho) | Primary |
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