IDAHO STATE UNIVERSITY (NPI# 1972720936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972720936 |
| Entity Type | Organization |
| Organization Name | IDAHO STATE UNIVERSITY |
| Other Organization Name | ISU DENTAL HYGIENE CLINIC |
| Practice Address |
999 Martin Luther King Jr. Way Pocatello ID 83209-8048 |
| Mailing Address |
921 S. 8th Ave., Stop 8048 Pocatello ID 83209-8048 |
| Practice Telephone | 2082823282 |
| Practice Fax Number | 2082825355 |
| Mailing Telephone | 2082823282 |
| Mailing Fax Number | 2082825355 |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. BRIAN ROBERT CRAWFORD (PROGRAM DIRECTOR DENTAL HYGIENE) |
| Authorized Official Telephone | 2082825275 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 8060975 | 05 |
| Other Name | Type Code |
|---|---|
| ISU Dental Hygiene Clinic | 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 |
| 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 |
| 1851516256 | Idaho State University | Dentist | 465 Memorial Dr., Pocatello, ID 83209-8088 | 2007-04-13 |
| Street Address |
999 MARTIN LUTHER KING JR. WAY |
| City | POCATELLO |
| State | ID |
| Zip Code | 83209-8048 |
| 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 | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649898578 | Michelle Ann Watkins | Dental Hygienist | 721 Northstar Dr, Hailey, ID 83333-8501 | 2020-07-07 |
| 1124644364 | Teena Barnes | Dental Hygienist | 3915 E 154 N, Rigby, ID 83442-5727 | 2020-06-23 |
| 1467966499 | Melanie Hill | Dental Hygienist | 550 W Sunnyside Rd Ste 7, Idaho Falls, ID 83402-4642 | 2017-11-29 |
| 1326575325 | Terrin Loe | Dental Hygienist | 358-786 Long Road, Plummer, ID 83851 | 2017-05-22 |
| 1427589936 | Jamie Rowe | Dental Hygienist | 581 N Whitewater Park Blvd Apt D202, Boise, ID 83702-5689 | 2017-03-26 |
| 1104207216 | Caring Smiles Pllc | Dental Hygienist | 8744 W. Fairview Ave, Boise, ID 83704 | 2015-06-15 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1790916476 | Thressa K. Fogleman | Dental Hygienist | 2355 American Legion Blvd, Mountain Home, ID 83647-3145 | 2009-07-29 |
| 1053563619 | Kellie Renee Bergendahl | Dental Hygienist | 427 12th St, Plummer, ID 83851-4000 | 2008-10-15 |
| 1093761694 | Family Health Services Corporation | Dental Hygienist | 402 6th St, Rupert, ID 83350 | 2006-05-25 |
| Find all providers with the same taxonomy | ||||
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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.