DR. JACE C. HANSEN DMD, MS - NPI 1003027400

Q: What is the provider's specialty?

The provider's specialty is Dentist with taxonomy code 1223P0300X and a focus in Periodontics.

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About Dr. Jace C. Hansen Dmd, Ms NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACE C. HANSEN DMD, MS (NPI 1003027400) is an individual periodontics provider in Boise, Idaho, licensed in Idaho (D-4290) and active in the NPI registry since May 2007. He maintains a secondary practice location in Boise.

NPPES Registry Identity

NPI1003027400

Entity TypeIndividualMale

Primary Taxonomy1223P0300X

Provider Legal NameDR. JACE C. HANSENCredential: DMD, MS

Location Address6019 N. EAGLE RD.Boise, ID 83713

Mailing Address6019 N. Eagle Rd.Boise, ID 83713 · (208) 377-2777 · Fax (208) 377-3075

Phone(208) 377-2777

Fax(208) 377-3075

Sole ProprietorYes

Enumeration DateMay 25, 2007

Last NPPES UpdateJune 23, 20212 updates tracked since enumeration

NPPES CertifiedJune 23, 2021

✔ NPI 1003027400 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · PeriodonticsDental Providers

Taxonomy Code1223P0300X

License✔ Licensed in ID · D-4290

Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

6019 N. EAGLE RD., Boise, ID 83713

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