NPIMap

Organization Active NPI

Idaho State University

Doing business as ISU Dental Hygiene Clinic

  • Dental Hygienist
  • Pocatello, ID
National Provider Identifier
1972720936
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
Legal business name
IDAHO STATE UNIVERSITY
Doing business as
ISU Dental Hygiene Clinic
Practice address
999 Martin Luther King Jr. Way
Pocatello, ID 83209-8048
Phone
(208) 282-3282
Fax
(208) 282-5355
NPI assigned
Apr 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Brian Robert Crawford, DDSNPI 1730304437
Title
Program Director Dental Hygiene
Phone
(208) 282-5275

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X NU Primary

Addresses

Primary practice location

999 Martin Luther King Jr. Way
Pocatello, ID 83209-8048

Mailing address

921 S. 8TH Ave., Stop 8048
Pocatello, ID 83209-8048
Phone (208) 282-3282

Other identifiers 1

IdentifierTypeStateIssuer
8060975MedicaidID

Other names 1

  • ISU Dental Hygiene Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Idaho State University22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

921 S 8th Ave
Stop 8048
Pocatello, ID 83209

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972720936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 S. 8TH AVE., STOP 8048",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832098048",
            "telephone_number": "208-282-3282",
            "fax_number": "208-282-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 MARTIN LUTHER KING JR. WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832098048",
            "telephone_number": "208-282-3282",
            "fax_number": "208-282-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR DENTAL HYGIENE",
        "authorized_official_telephone_number": "208-282-5275",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8060975",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ISU Dental Hygiene Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.