Individual provider Active NPI

Craig D Blaisdell, D.D.S

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1942406715
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D4070 Issued in ID
Practice address
8877 W Hackamore Dr
Boise, ID 83709-1671
Phone
(208) 377-9696
Fax
(208) 377-9698
NPI assigned
Jun 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D4070 ID Primary

Addresses

Primary practice location

8877 W Hackamore Dr
Boise, ID 83709-1671

Mailing address

8877 W Hackamore Dr
Boise, ID 83709-1671
Phone (208) 377-9696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D4070IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Craig D. Blaisdell, DDS, PLLC General Practice CurrentSince Nov 9, 2025 Accepting new patients
Lynn R. Blaisdell, DDS, PA General Practice PastSince Nov 9, 2025 Accepting new patients

Locations

8877 W Hackamore Dr
Boise, ID 83709
Phone (208) 377-9696

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762214400000",
    "number": "1942406715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8877 W HACKAMORE DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091671",
            "telephone_number": "208-377-9696",
            "fax_number": "208-377-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8877 W HACKAMORE DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091671",
            "telephone_number": "208-377-9696",
            "fax_number": "208-377-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAISDELL",
        "first_name": "CRAIG",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-26",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; 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.