| Jack C. Kulm Dmd Pa | |
|
410 N Idaho St Wendell ID 83355 | |
| (208) 536-5441 | |
| (208) 536-5873 |
| Full Name | Jack C. Kulm Dmd Pa |
|---|---|
| Speciality | Dentist |
| Location | 410 N Idaho St, Wendell, Idaho |
| Authorized Official Name and Position | Jack Kulm (PRESIDENT) |
| Authorized Official Contact | 2085365441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack C. Kulm Dmd Pa 410 N Idaho St Wendell ID 83355 Ph: (208) 536-5441 | Jack C. Kulm Dmd Pa 410 N Idaho St Wendell ID 83355 Ph: (208) 536-5441 |
| NPI Number | 1932364387 |
|---|---|
| Provider Enumeration Date | 07/25/2008 |
| Last Update Date | 07/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932364387 | NPI | - | NPPES |
| 002488200 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D-1679 (Idaho) | Primary |
Todays Dental Care Wendell Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 N Idaho St, Wendell, ID 83355 Phone: 208-536-5441 Fax: 208-536-5873 |