Organization
IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACE C. HANSEN DMD MS (OWNER)
(208) 377-2777
Entity
Organization
Contact information
Practice address
6019 N EAGLE RD, BOISE, ID 83713-0997
(208) 377-2777
(208) 377-3075
Mailing address
6019 N EAGLE RD, BOISE, ID 83713-0997
(208) 377-2777
(208) 377-3075
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D-4290
ID
Other
Enumeration date
06/20/2016
Last updated
06/20/2016
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