Sunnyside Dental Care Pc | |
1520 Elk Creek Dr Idaho Falls ID 83404-8322 | |
(208) 522-8854 | |
Not Available |
Full Name | Sunnyside Dental Care Pc |
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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 |
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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 |
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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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