Individual
DR. JEREMIAH MCKELL FUNK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
410 N IDAHO ST, WENDELL, ID 83355-5038
(208) 536-5441
Mailing address
410 N IDAHO ST, WENDELL, ID 83355-5038
(208) 536-5441
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
28007
TX
122300000X
Dentist
Primary
D-4555
ID
Other
Enumeration date
07/09/2012
Last updated
02/20/2023
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