NPI age
19 years
Enumerated 2007-04-13
● Active Type 2 · Organization
Subpart
Idaho State University
Idaho State University is 1 of 1099 dentist organizations in Idaho.
Primary specialty
Dentist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Crawford
Program Director Iagd
Last NPPES update
2008-03-24
Source: monthly bulk 2026-05
How this organization compares
Across 1099 active dentist providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-04Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
465 Memorial Dr.
Pocatello, ID 832098088
Mailing address
921 S. 8th Ave., Stop 8088
Pocatello, ID 832098088
Authorized official
Brian Robert Crawford, DDS
Program Director Iagd
📞 2082825275
Individual providers at this organization
3 individual providers on file at this primary practice address.
- Kristen Caldwell, PHARMD Pharmacist NPI 1942058318
- Brian Crawford, DDS Dentist NPI 1730304437
- Jessica Hetcko, DDS Dentist NPI 1356507925
Specialties
-
Dentist PrimaryA general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 181764 | |
| 05 (ID) | 8057101 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Pocatello Family Dentistry
Practice context
Multi-provider organization. 3 individual providers on file at this primary address.
Subpart of Idaho State University.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.