Idaho Perio Center For Dental Implants & Laser Periodontal Therapy | |
6019 N Eagle Rd Boise ID 83713-0997 | |
(208) 377-2777 | |
(208) 377-3075 |
Full Name | Idaho Perio Center For Dental Implants & Laser Periodontal Therapy |
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Speciality | Dentist - Periodontics |
Location | 6019 N Eagle Rd, Boise, Idaho |
Authorized Official Name and Position | Jace C. Hansen (OWNER) |
Authorized Official Contact | 2083772777 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Idaho Perio Center For Dental Implants & Laser Periodontal Therapy 6019 N Eagle Rd Boise ID 83713-0997 Ph: (208) 377-2777 | Idaho Perio Center For Dental Implants & Laser Periodontal Therapy 6019 N Eagle Rd Boise ID 83713-0997 Ph: (208) 377-2777 |
NPI Number | 1194175232 |
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Provider Enumeration Date | 06/20/2016 |
Last Update Date | 06/20/2016 |
Identifier | Type | State | Issuer |
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1194175232 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0300X | Dentist - Periodontics | D-4290 (Idaho) | Primary |
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