# DR. KACI B. JENSEN, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255339297
- **Authorized official:** DR. KACI B. JENSEN DDS (OWNER)
- **Authorized official phone:** (208) 791-4926

## Contact information

- **Practice address:** 9755 W LEO DR, BOISE, ID 83709-8249
- **Practice address phone:** (208) 791-4926
- **Mailing address:** 9755 W LEO DR, BOISE, ID 83709-8249
- **Mailing address phone:** (208) 791-4926

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-4034 | ID | Yes |
| 261QD0000X | Dental Clinic/Center | 2000159748 | MO | — |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 03/07/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 807602800 | — | ID |