NPI 1003027400

Jace C. Hansen, DMDMS

Practitioner Periodontics Boise, ID

Practice location

Address: 6019 N. Eagle Rd., Boise, ID 83713
Phone: (208) 377-2777
Fax: (208) 377-3075

Registered specialties (2)

Periodontics Primary

Dental Providers Taxonomy 1223P0300X Licence D-4290 (ID)

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Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1003027400
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 May 2007
Record last updated: 23 Jun 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.