Idaho Perio Center for Dental Implants & Laser Periodontal Therapy
Organization Active NPI Periodontics · Boise, ID
NPI 1194175232 · NPPES record last updated Jun 20, 2016
Key facts
- NPI
- 1194175232
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Periodontics 1223P0300X
- License
- D-4290 (ID)
- Legal business name
- IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY
- Practice address
- 6019 N Eagle Rd
Boise, ID 83713-0997 - Phone
- (208) 377-2777
- Fax
- (208) 377-3075
- NPI assigned
- Jun 20, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Jace C. Hansen, DMD MS
- Title
- Owner
- Phone
- (208) 377-2777
National Provider Directory
Locations
6019 N Eagle Rd
Boise, ID 83713
Phone (208) 377-2777
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics |
1223P0300X | D-4290 | ID | Yes |
Addresses
Primary practice location
6019 N Eagle Rd
Boise, ID 83713-0997
Mailing address
6019 N Eagle Rd
Boise, ID 83713-0997
Phone (208) 377-2777
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- Idaho Physical Medicine & Rehabilitation
- Idaho Pulmonary Associates, PA
- Idaho Radiology Associates PLLC
- Idaho Retina Center PLLC
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.