IDAHO STATE UNIVERSITY (NPI# 1851516256) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851516256 |
| Entity Type | Organization |
| Organization Name | IDAHO STATE UNIVERSITY |
| Other Organization Name | POCATELLO FAMILY DENTISTRY |
| Practice Address |
465 Memorial Dr. Pocatello ID 83209-8088 |
| Mailing Address |
921 S. 8th Ave., Stop 8088 Pocatello ID 83209-8088 |
| Practice Telephone | 2082826000 |
| Practice Fax Number | 2082824950 |
| Mailing Telephone | 2082826000 |
| Mailing Fax Number | 2082824950 |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2008-03-24 |
| Authorized Official Name | DR. BRIAN ROBERT CRAWFORD (PROGRAM DIRECTOR IAGD) |
| Authorized Official Telephone | 2082825275 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | IDAHO STATE UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 181764 | 05 | |
| ID | 8057101 | 05 |
| Other Name | Type Code |
|---|---|
| Pocatello Family Dentistry | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811595929 | Idaho State University | Counselor | 1400 E Terry Dr Bldg 63, Pocatello, ID 83209-0001 | 2020-10-12 |
| 1801292115 | Idaho State University | Family Medicine | 921 S 8th Ave Stop 8173, Sports and Orthopaedic Center, Pocatello, ID 83209-8173 | 2014-11-13 |
| 1730351081 | Idaho State University | Pharmacy | 990 South 8th, Pocatello, ID 83209 | 2008-03-27 |
| 1972720936 | Idaho State University | Dental Hygienist | 999 Martin Luther King Jr. Way, Pocatello, ID 83209-8048 | 2007-04-19 |
| 1356491187 | Idaho State University | Physical Therapist | 1400 E. Terry, Garrison Bldg. 63 #202, Pocatello, ID 83209-8045 | 2007-01-12 |
| 1578508081 | Idaho State University | Audiologist | 650 Memorial Drive, # 68, Pocatello, ID 83209-0001 | 2006-06-18 |
| 1235737347 | Idaho State University | Clinic/Center | 1311 E Central Dr, Meridian, ID 83642-7991 | 2020-10-12 |
| 1295105567 | Idaho State University | Clinical Medical Laboratory | 970 S 5th Ave, Stop 8288, Pocatello, ID 83209-0001 | 2015-09-30 |
| 1114285996 | Idaho State University | Local Education Agency (LEA) | 921 S 8th Ave, Mail Stop 8219, Pocatello, ID 83209-8219 | 2012-04-30 |
| 1912110164 | Idaho State University | Dentist | 2033 E Summersweet Dr, Boise, ID 83716-6695 | 2007-05-07 |
| Street Address |
465 MEMORIAL DR. |
| City | POCATELLO |
| State | ID |
| Zip Code | 83209-8088 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205957594 | Mary Allison Harper | Dentist | 465 Memorial Dr., Pocatello, ID 83209-8088 | 2007-04-03 |
| 1356507925 | Jessica Beth Hetcko | Dentist | 465 Memorial Dr., Pocatello Family Dentistry Isu, Pocatello, ID 83209-8088 | 2008-08-04 |
| 1730304437 | Brian Robert Crawford | Dentist | 465 Memorial Dr., Pocatello, ID 83209-8088 | 2007-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093097081 | Eydie Kendall | Physical Therapist | 1400 Terry Drive, Pocatello, ID 83209 | 2011-09-15 |
| 1548548589 | Corrie Elizabeth Holmes | Audiologist | 650 Memorial Drive Building 68, Pocatello, ID 83209 | 2011-07-25 |
| 1730351081 | Idaho State University | Pharmacy | 990 South 8th, Pocatello, ID 83209 | 2008-03-27 |
| 1922204551 | Melody Ann Weaver | Nurse Practitioner | 921 S 8th Ave Stop 8101, Pocatello, ID 83209 | 2007-06-21 |
| 1710482500 | Ashley Letson | Specialist/Technologist | 921 S 8th Ave, Mcintosh Manor D9, Pocatello, ID 83209 | 2018-03-26 |
| 1407261407 | Stephen B Grandy | Dentist | 465 Memorial Drive, Pocatello, ID 83209-0000 | 2014-06-27 |
| 1811595929 | Idaho State University | Counselor | 1400 E Terry Dr Bldg 63, Pocatello, ID 83209-0001 | 2020-10-12 |
| 1174149389 | Santiago A Segura Barron | Specialist/Technologist | Holt Arena 550 Memorial Drive Building 50, Pocatello, ID 83209-0001 | 2020-06-23 |
| 1639658248 | Luis Rodriguez | Psychologist | 1400 Eas Terry Dr Bldg 63 Garrison Hall 5th Floor, Pocatello, ID 83209-0001 | 2018-08-14 |
| 1205384484 | Max Esposito | Physical Medicine & Rehabilitation | 1400 E Terry Dr, Pocatello, ID 83209-0001 | 2016-09-15 |
| Find all providers in zip 83209 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982119459 | Good Blood Pllc | Dentist | 4165 Yellowstone Ave, Pocatello, ID 83202-2414 | 2017-12-06 |
| 1952822686 | Connor Fairbanks | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2017-07-03 |
| 1326281163 | Care Creek Dental LLC | Dentist | 1169 Call Creek Dr Ste A, Pocatello, ID 83201-3077 | 2009-04-09 |
| 1306005236 | Olympus Family Dental | Dentist | 1598 Delphic Way Ste B, Pocatello, ID 83201-2200 | 2008-06-05 |
| 1730348806 | Call Family Dentistry | Dentist | 1352 E Center St Ste B, Pocatello, ID 83201-4769 | 2008-06-04 |
| 1215102439 | Four Season Dental PC | Dentist | 115 E Chapel Rd, Pocatello, ID 83201 | 2008-04-29 |
| 1174797716 | Carl B. Holm, D.d.s., P.C. | Dentist | 350 E Cedar St, Suite A, Pocatello, ID 83201-3709 | 2008-04-15 |
| 1790999407 | Allied Dental Clinic, PC | Dentist | 1246 Yellowstone Ave Ste B3, Pocatello, ID 83201-4372 | 2007-05-10 |
| 1205957594 | Mary Allison Harper | Dentist | 465 Memorial Dr., Pocatello, ID 83209-8088 | 2007-04-03 |
| 1215072798 | Robert L Fackrell | Dentist | 415 N 3rd Ave Ste A, Pocatello, ID 83201-6306 | 2007-02-21 |
| Find all providers in POCATELLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.