Pocatello Family Dentistry

LBN: Idaho State University
Pocatello Family Dentistry is an health care organization with primary practice located at 465 Memorial Dr. , Pocatello ID 83209-8088. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty. Idaho State University can be contacted via phone (208) 282-6000, or through Crawford, Brian Robert via phone (208) 282-5275.

Contact Information

Primary practice address
465 Memorial Dr. Pocatello ID 83209-8088
Phone: (208) 282-6000
Fax: (208) 282-4950
Website:
Map and Directions
Authorized official contact:
Name: Crawford, Brian Robert Doctor of Dental Surgery (DDS)
Phone: (208) 282-5275

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X Idaho

Profile Details

NPI number 1851516256
LBN Legal business name Idaho State University
DBA Doing business as Pocatello Family Dentistry
Authorized official Crawford, Brian Robert Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 Yes
Enumeration date Apr 13th, 2007
Last updated Mar 24th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851516256 NPPES
Idaho MEDICAID 181764
Idaho MEDICAID 8057101

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