Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Dental Hygiene Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN ROBERT CRAWFORD DDS (PROGRAM DIRECTOR DENTAL HYGIENE)
(208) 282-5275
Entity
Organization
Contact information
Practice address
999 MARTIN LUTHER KING JR. WAY, POCATELLO, ID 83209-8048
(208) 282-3282
(208) 282-5355
Mailing address
921 S. 8TH AVE., STOP 8048, POCATELLO, ID 83209-8048
(208) 282-3282
(208) 282-5355
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8060975
—
ID
Enumeration date
04/19/2007
Last updated
08/22/2020
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