NPIMap

Organization Active NPI

Idaho Perio Center for Dental Implants & Laser Periodontal Therapy

  • Periodontics
  • Boise, ID
National Provider Identifier
1194175232
Registry record updated Jun 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
D-4290 Issued in 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
Last updated
Jun 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jace C. Hansen, DMD MSNPI 1003027400
Title
Owner
Phone
(208) 377-2777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X D-4290 ID Primary

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466380800000",
    "number": "1194175232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6019 N EAGLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130997",
            "telephone_number": "208-377-2777",
            "fax_number": "208-377-3075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 N EAGLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130997",
            "telephone_number": "208-377-2777",
            "fax_number": "208-377-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-06-20",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "JACE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-377-2777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D-4290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.