Active NPI
Jay Clayton Hansen II, DDS
- Dentist
- Moscow, ID
National Provider Identifier
1609129519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D3853
- Practice address
- 1526 S Levick St
Moscow, ID 83843-2560 - Phone
- (208) 882-4923
- Fax
- (208) 882-8418
- NPI assigned
- Oct 17, 2012
- Last updated
- Oct 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D3853 | ID | Primary |
Addresses
Primary practice location
1526 S Levick St
Moscow, ID 83843-2560
Mailing address
1526 S Levick St
Moscow, ID 83843-2560
Phone (208) 882-4923
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3853 | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J Clayton Hansen DDS PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350432000000",
"number": "1609129519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1526 S LEVICK ST",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838432560",
"telephone_number": "208-882-4923",
"fax_number": "208-882-8418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1526 S LEVICK ST",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838432560",
"telephone_number": "208-882-4923",
"fax_number": "208-882-8418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "JAY",
"middle_name": "CLAYTON",
"name_suffix": "II",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-17",
"last_updated": "2012-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D3853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.