# JACK C. KULM DMD PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932364387
- **Authorized official:** JACK KULM DMD (PRESIDENT)
- **Authorized official phone:** (208) 536-5441

## Contact information

- **Practice address:** 410 N IDAHO ST, WENDELL, ID 83355
- **Practice address phone:** (208) 536-5441
- **Practice address fax:** (208) 536-5873
- **Mailing address:** 410 N IDAHO ST, WENDELL, ID 83355
- **Mailing address phone:** (208) 536-5441
- **Mailing address fax:** (208) 536-5873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-1679 | ID | Yes |

## Other

- **Enumeration date:** 07/25/2008
- **Last updated:** 07/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002488200 | — | ID |