Organization
JACK C. KULM DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK KULM DMD (PRESIDENT)
(208) 536-5441
Entity
Organization
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
D-1679
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002488200
—
ID
Enumeration date
07/25/2008
Last updated
07/25/2008
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