IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY (NPI# 1194175232) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194175232 |
| Entity Type | Organization |
| Organization Name | IDAHO PERIO CENTER FOR DENTAL IMPLANTS & LASER PERIODONTAL THERAPY |
| Practice Address |
6019 N Eagle Rd Boise ID 83713-0997 |
| Practice Telephone | 2083772777 |
| Practice Fax Number | 2083773075 |
| Mailing Telephone | 2083772777 |
| Mailing Fax Number | 2083773075 |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2016-06-20 |
| Authorized Official Name | DR. JACE C. HANSEN (OWNER) |
| Authorized Official Telephone | 2083772777 |
| Authorized Official Credential | DMD MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
D-4290 | ID | Dental Providers |
| Street Address |
6019 N EAGLE RD |
| City | BOISE |
| State | ID |
| Zip Code | 83713-0997 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780635037 | Taylor Coleman Clark | Dentist | 6019 N Eagle Rd, Boise, ID 83713 | 2006-05-12 |
| 1366824484 | Kip T Katseanes | Dentist | 6019 N Eagle Rd, Boise, ID 83713 | 2015-06-25 |
| 1033429899 | Logan Marsh Lamprecht | Counselor | 6019 N Eagle Rd, Boise, ID 83713-0997 | 2010-10-14 |
| 1053540898 | All About You Dental, PC | Clinic/Center | 6019 N Eagle Rd, Boise, ID 83713-0997 | 2009-07-14 |
| 1851554737 | Stacy J. Moon Dds, Pa | Clinic/Center | 6019 N Eagle Rd, Boise, ID 83713-0997 | 2008-07-09 |
| 1124035472 | Robert William Arthur French Ix | Dentist | 6019 N Eagle Rd, Boise, ID 83713-0997 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972968998 | Treasure Valley Periodontics | Dentist | 813 N Stilson Rd Ste C, Boise, ID 83703-5119 | 2015-12-17 |
| 1689077026 | Florence and Lincks and Associates | Dentist | 140 E Boise Ave Ste A, Boise, ID 83706-4374 | 2014-09-30 |
| 1588827125 | Richard E. Ferguson D.d.s.,m.s. Pa | Dentist | 813 Stilson Rd Ste C, Boise, ID 83703-5119 | 2008-07-03 |
| 1245310036 | Kenneth G. Sherman II | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2006-10-16 |
| 1700994852 | Bradley Lynn Townsend | Dentist | 6019 N. Eagle Rd., Boise, ID 83713 | 2006-08-28 |
| 1235147281 | Michael John Florence | Dentist | 140 East Boise Avenue, Boise, ID 83706 | 2006-08-04 |
| 1346224458 | Jack H Lincks | Dentist | 140 E Boise Ave, Boise, ID 83706-4373 | 2005-12-01 |
| 1447481726 | Stephen Schenk, D.d.s., P.C. | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2009-08-04 |
| 1871765974 | Stephen Frederick Schenk | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2008-03-28 |
| 1710050943 | Richard E Ferguson | Dentist | 813 Stilson Rd, Suite C, Boise, ID 83703-5119 | 2006-11-16 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.