Individual
DR. DOMENICK FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
921 S 8TH AVE, POCATELLO, ID 83209-0002
(208) 282-3289
Mailing address
397 E SHEPARD LN, KAYSVILLE, UT 84037-9637
(801) 499-0507
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9271560
ID
Other
Enumeration date
05/28/2025
Last updated
06/04/2025
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