| Dr. Kaci B. Jensen, Pllc | |
|
9755 W Leo Dr Boise ID 83709-8249 | |
| (208) 791-4926 | |
| Not Available |
| Full Name | Dr. Kaci B. Jensen, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9755 W Leo Dr, Boise, Idaho |
| Authorized Official Name and Position | Kaci B. Jensen (OWNER) |
| Authorized Official Contact | 2087914926 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Kaci B. Jensen, Pllc 9755 W Leo Dr Boise ID 83709-8249 Ph: (208) 791-4926 | Dr. Kaci B. Jensen, Pllc 9755 W Leo Dr Boise ID 83709-8249 Ph: (208) 791-4926 |
| NPI Number | 1255339297 |
|---|---|
| Provider Enumeration Date | 07/13/2005 |
| Last Update Date | 03/07/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255339297 | NPI | - | NPPES |
| 807602800 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-4034 (Idaho) | Primary |
| 261QD0000X | Clinic/center - Dental | 2000159748 (Missouri) | Secondary |
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