Sunnyside Dental Care PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1853 Issued in ID

Legal business name

SUNNYSIDE DENTAL CARE PC

Practice address

1520 Elk Creek Dr
Idaho Falls, ID 83404-8322

Phone

(208) 522-8854

NPI assigned

Dec 1, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Evan O Johnson, D.M.D.

Title

President

Phone

(208) 522-8854

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1003144114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-522-8854",
            "fax_number": "208-535-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-522-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNNYSIDE DENTAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-01",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "EVAN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-522-8854",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Summit Health Professionals
• Summit Orthopaedics Management and Consulting, LLC (Summit Orthopaedics)
• Summit Orthopaedics Management and Consulting, LLC
• Summus Counseling, LLC
• Sunnyside Dental Care LLC
• Sunnyside Surgery Center, LLC
• Sunrise Ketamine Clinic LLC
• Deena Surerus, LPN
• Surgery Center Anesthesia PLLC
• Brent Michael Sutherland, CRNA

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.