Johnson, Evan O
Johnson, Evan O is an individual health care provider with primary practice located at 1520 Elk Crk , Idaho Falls ID 83404-8322. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Johnson, Evan O can be contacted via phone (208) 522-8854.Contact Information
Primary practice address
1520 Elk Crk
Idaho Falls ID 83404-8322
Phone: (208) 522-8854
Fax: (208) 535-0551
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | D1853 | Idaho |
Profile Details
| NPI number | 1891756599 |
|---|---|
| LBN Legal business name | Johnson, Evan O |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 31st, 2006 |
| Last updated | May 19th, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891756599 | NPPES |
| Idaho | MEDICAID | 001263500 |
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