Individual
DR. JACE C. HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
6019 N. EAGLE RD., BOISE, ID 83713
(208) 377-2777
(208) 377-3075
Mailing address
6019 N. EAGLE RD., BOISE, ID 83713
(208) 377-2777
(208) 377-3075
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D-4290
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
KY
Other
Enumeration date
05/25/2007
Last updated
06/23/2021
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