Jack C. Kulm DMD PA

Primary specialty

DentistTaxonomy code 122300000X

License

D-1679 Issued in ID

Legal business name

JACK C. KULM DMD PA

Practice address

410 N Idaho St
Wendell, ID 83355

Phone

(208) 536-5441

Fax

(208) 536-5873

NPI assigned

Jul 25, 2008

Last updated

Jul 25, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack Kulm, DMDNPI 1275641540

Title

President

Phone

(208) 536-5441

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack C Kulm, DMD PA

  • Dentist
  • Wendell, ID
  • NPI 1275641540
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1932364387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N IDAHO ST",
            "city": "WENDELL",
            "state": "ID",
            "postal_code": "83355",
            "telephone_number": "208-536-5441",
            "fax_number": "208-536-5873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N IDAHO ST",
            "city": "WENDELL",
            "state": "ID",
            "postal_code": "83355",
            "telephone_number": "208-536-5441",
            "fax_number": "208-536-5873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK C. KULM DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-25",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "KULM",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-536-5441",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-1679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002488200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jeremiah McKell Funk, DDS
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• Jake Naisbitt, PT, DPT

• Dentist in Wendell, ID
• Providers in Wendell, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.