NPI age
19 years
Enumerated 2007-03-01
● Active
Type 1 · Individual
Jack Alan Fullwiler, DDS
Fullwiler is 1 of 40 dentist providers in Coeur D Alene and 1 of 591 in Idaho.
Primary specialty
Dentist
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2007-07-08
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 591 active dentist providers in Idaho.
NPI age
19 years
↑ 3 yr above median (16 yr)
State licenses
1 state
11% of peers hold multiple states
Subspecialties
0
17% of peers hold subspecialties
NPI lifetime · 2007 → 2026
2007-03Enumerated in NPPES
2007
2026
Where they practice
Practice location
1223 N Government Way
Coeur D Alene, ID 83814
Mailing address
1223 N Government Way
Coeur D Alene, ID 83814
Specialties
-
Dentist PrimaryA dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | 000010009552 | REGENCE BLUE SHIELD |
| 01 | 07068 | WASHINGTON DENT SERV |
Practice context
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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