Organization
DR. KACI B. JENSEN, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KACI B. JENSEN DDS (OWNER)
(208) 791-4926
Entity
Organization
Contact information
Practice address
9755 W LEO DR, BOISE, ID 83709-8249
(208) 791-4926
Mailing address
9755 W LEO DR, BOISE, ID 83709-8249
(208) 791-4926
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4034
ID
261QD0000X
Dental Clinic/Center
2000159748
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807602800
—
ID
Enumeration date
07/13/2005
Last updated
03/07/2011
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