JACK FULLWILER, DDS

Dentist

Active Individual
NPI: 1518095678

Practice Address

1223 N GOVERNMENT WAY
Coeur D Alene, ID 83814

Phone: (208) 664-9225

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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