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

Jack Alan Fullwiler, DDS

Individual provider Dentist · NPI 1518095678

Jack Alan Fullwiler, DDS is a Dentist in Coeur D Alene, Idaho. Licensed in Idaho. Registered with an NPI since 2007.

Licensed in
ID
In the registry since
2007
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.

See every abbreviation used in this directory →

Practice location Address checks out

1223 N Government Way
Coeur D Alene, ID 83814
Phone: (208) 664-9225
Fax: (208) 667-3699
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D1747 (ID)

Record details

NPI number1518095678
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedMarch 1, 2007
Last updated in NPPESJuly 8, 2007
Mailing address1223 N Government Way, Coeur D Alene, ID 83814

Other providers in Coeur D Alene