Individual
JAY CLAYTON HANSEN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1526 S LEVICK ST, MOSCOW, ID 83843-2560
(208) 882-4923
(208) 882-8418
Mailing address
1526 S LEVICK ST, MOSCOW, ID 83843-2560
(208) 882-4923
(208) 882-8418
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3853
ID
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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