IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY NPI 1194175232

NPI Information

IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY is a periodontics dentist in Boise, ID. The provider is 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. IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY NPI is 1194175232. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6019 N EAGLE RD
BOISE, ID
ZIP 83713-997
Phone: (208) 377-2777
Fax: (208) 377-3075

The provider's authorized official is Jace C. Hansen .
The authorized official title is Owner and has the following contact phone number (208) 377-2777.

The enumeration date for this NPI number is 6/20/2016 and was last updated on 6/20/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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