Individual
JACK C KULM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD PA
Contact information
Practice address
410 N IDAHO ST, WENDELL, ID 83355
(208) 536-5441
(208) 536-5873
Mailing address
410 N IDAHO ST, WENDELL, ID 83355
(208) 536-5441
(208) 536-5873
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1679
ID
Other
Enumeration date
08/28/2006
Last updated
07/08/2007
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