Scott Charles Grilliot, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D-5639 Issued in ID

Practice address

921 S 8TH Ave Stop 8088
Pocatello, ID 83209-4008

Phone

(208) 282-1040

Fax

(208) 282-1040

NPI assigned

Jun 13, 2024

Last updated

Jun 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Idaho State University

  dba Pocatello Family Dentistry

  • General Practice Dentistry
  • Pocatello, ID
  • NPI 1851516256
  NPD (past)

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1629811278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E VENTURE WAY APT 3104",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832011203",
            "telephone_number": "309-830-5306",
            "fax_number": "208-282-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 S 8TH AVE STOP 8088",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832094008",
            "telephone_number": "208-282-1040",
            "fax_number": "208-282-1040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRILLIOT",
        "first_name": "SCOTT",
        "middle_name": "CHARLES",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lippsusa@health.isu.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "921 S 8th Ave Stop 8088",
            "city": "Pocatello",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832094008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Suzanne Grinnell
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• Dentist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.