# IDAHO STATE UNIVERSITY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912110164
- **Authorized official:** MS. TINA M FREEMAN BHSA (OFFICE MANAGER)
- **Authorized official phone:** (208) 331-0182

## Contact information

- **Practice address:** 2033 E SUMMERSWEET DR, BOISE, ID 83716-6695
- **Practice address phone:** (208) 331-0182
- **Practice address fax:** (208) 331-0184
- **Mailing address:** 2033 E SUMMERSWEET DR, BOISE, ID 83716-6695
- **Mailing address phone:** (208) 331-0182
- **Mailing address fax:** (208) 331-0184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-1819 | ID | Yes |

## Other

- **Enumeration date:** 05/07/2007
- **Last updated:** 06/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 807200600 | — | ID |