JACK FULLWILER, DDS
Dentist
Active
Individual
NPI: 1518095678
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Dentist | 122300000X | Yes | D1747 (ID) |
Frequently Asked Questions
NPI 1518095678 is the National Provider Identifier for JACK FULLWILER, DDS, a Dentist provider located in Coeur D Alene, ID. This NPI was enumerated on March 1, 2007.
JACK FULLWILER, DDS practices at 1223 N GOVERNMENT WAY, Coeur D Alene, ID 83814.
Quick Facts
- NPI
- 1518095678
- Type
- Individual
- Enumerated
- Mar 1, 2007
- Last Updated
- Jul 8, 2007
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