IDAHO STATE UNIVERSITY
NPI: 1972720936
· POCATELLO, ID 83209
· Dental Hygienist
· NPI assigned 04/19/2007
$340.00
Total Medicaid Paid
Provider Details
| Authorized Official | CRAWFORD, BRIAN (PROGRAM DIRECTOR DENTAL HYGIENE) |
| NPI Enumeration Date | 04/19/2007 |
Related Entities
Other providers sharing the same authorized official: CRAWFORD, BRIAN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
19 |
$340.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
19 |
19 |
$340.00 |