Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ian Jacob Fullinfaw, DDS

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1861187205

Ian Jacob Fullinfaw, DDS is a Student in an Organized Health Care Education/Training Program in Council Bluffs, Iowa. Works from 2 locations. Licensed in Connecticut, Iowa and Nebraska.

Licensed in
CT, IA, NE
In the registry since
2023
Specialties on file
3
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

1026 Woodbury Ave
Council Bluffs, IA 51503-7915
Phone: (712) 201-8891
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 14133 Q St, Omaha, NE 68137-2600 — (402) 506-5100

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence DDS-10256 (IA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence 13750 (CT)
General Practice Dentistry Taxonomy 1223G0001X · Licence 7932 (NE)

Record details

NPI number1861187205
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedApril 11, 2023
Last updated in NPPESOctober 16, 2024
Certification dateOctober 16, 2024
Mailing address15711 Lakeside Cir, Omaha, NE 68135-1103

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