Jack Alan Fullwiler in Coeur D Alene - Dentist
Jack Alan Fullwiler - NPI 1518095678
Jack Alan Fullwiler is a Dentist in Coeur D Alene, Idaho. Jack Alan Fullwiler practices all healthcare services and medical treatments related to Dentist. The NPI Number for Jack Alan Fullwiler is 1518095678. The last update date is 2007-07-08.
Jack Alan Fullwiler's current location address is 1223 N Government Way, Coeur D Alene, Idaho. You can contact this provider via phone number 2086649225 and fax number 2086673699. The mailing address for Jack Alan Fullwiler is 1223 N Government Way, Coeur D Alene, Idaho. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack Alan Fullwiler |
|---|---|
| Address | 1223 N Government Way, Coeur D Alene, Idaho |
| Phone Number | 2086649225 |
| Fax Number | 2086673699 |
| Sole Proprietor | N |
| Credentials | DDS |
NPI Number Detail
| NPI Number | 1518095678 |
|---|---|
| Provider Enumeration Date | 2007-03-01 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 1223 N Government Way |
|---|---|
| City | Coeur D Alene |
| State | Idaho (ID) |
| Post Code | 83814 |
| Phone Number | 2086649225 |
| Fax Number | 2086673699 |
Provider's Primary Taxonomy Detail
| Speciality | Dentist |
|---|---|
| Taxonomy | 122300000X |
| Licence No | D1747 |
|
Definition: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: denti |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 10009552 | REGENCE BLUE SHIELD | ||
| 7068 | WASHINGTON DENT SERV |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Jack Alan Fullwiler by the Centers for Medicare & Medicaid Services?
The Jack Alan Fullwiler has been issued the NPI (National Provider Identifier) 1518095678, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete physical location address of Jack Alan Fullwiler?
The Jack Alan Fullwiler is physically situated at 1223 N Government Way, in the city of Coeur D Alene, state of ID, with the postal code 83814.
What is Jack Alan Fullwiler's specialized field of practice, and what is the corresponding taxonomy code that categorizes this area of expertise?
The area of specialization for Jack Alan Fullwiler is Dentist, and the taxonomy code that classifies this field of practice is 122300000X.
On what date did the Centers for Medicare & Medicaid Services assign the 1518095678 to Jack Alan Fullwiler?
The Centers for Medicare & Medicaid Services assigned the 1518095678 to Jack Alan Fullwiler on 2007-03-01.
When was the information regarding Jack Alan Fullwiler most recently updated?
The details pertaining to the Jack Alan Fullwiler, including its address, specialty, and other relevant information, were last refreshed on 2007-07-08.
NPI Number: 1235130048
Address: 1770 N Orange Grove Ave Ste 101, Pomona, CA