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DR. DOMENICK FULLER DDS
NPI 1649063850
Dentist - General Practice in Pocatello, ID

Active since May 28, 2025
921 S 8TH AVE, POCATELLO, ID 83209(208) 282-3289 Get Directions Write a Review

NPPES record last updated: June 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 4, 2025, May 28, 2025 (2 updates tracked since 2025).

About Dr. Domenick Fuller Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DOMENICK FULLER DDS (NPI 1649063850) is an individual general practice provider in Pocatello, Idaho, licensed in Idaho (9271560) and active in the NPI registry since May 2025.

NPPES Registry Identity

NPI1649063850
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. DOMENICK FULLERCredential: DDS
Location Address921 S 8TH AVEPocatello, ID 83209-0002
Mailing Address397 E Shepard LnKaysville, UT 84037-9637 · (801) 499-0507
Phone(208) 282-3289
Sole ProprietorNo
Enumeration DateMay 28, 2025
Last NPPES UpdateJune 4, 20252 updates tracked since enumeration
NPPES CertifiedJune 4, 2025
✔ NPI 1649063850 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in ID · 9271560
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
921 S 8TH AVE, Pocatello, ID 83209
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BAILEY CAROLINE FRY ATS
Specialist/Technologist (Athletic Trainer)
921 S 8TH AVE
POCATELLO, ID 83209
Bannock County (208) 240-3247
HANNA MYKAL CROZIER
Student in an Organized Health Care Education/Training Program
921 S 8TH AVE
POCATELLO, ID 83209
Bannock County (208) 530-3692
IDAHO STATE UNIVERSITY
Local Education Agency (LEA)
921 S 8TH AVE, MAIL STOP 8219
POCATELLO, ID 83209
Bannock County (208) 282-3540
DR. DUSTYN SLADE LEE WALTON PT, DPT, ATC
Physical Therapist (Sports)
921 S 8TH AVE
POCATELLO, ID 83209
Bannock County (307) 696-5885
DILLON CLARK
Student in an Organized Health Care Education/Training Program
921 S 8TH AVE
POCATELLO, ID 83209
Bannock County (208) 282-4636
MICHELLE METCALF DMD
Dentist
921 S 8TH AVE, CAMPUS BOX 8088
POCATELLO, ID 83209
Bannock County (208) 282-6000
RACHEL ERIN GEOGHEGAN ATC
Specialist/Technologist (Athletic Trainer)
921 S 8TH AVE
POCATELLO, ID 83209
Bannock County (208) 479-9142
COBY YOUNG
Specialist/Technologist (Athletic Trainer)
921 S 8TH AVE
POCATELLO, ID 83209
Bannock County (208) 589-9324

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Domenick Fuller's NPI number?

The NPI number for Domenick Fuller is 1649063850. It was assigned to this individual provider in the NPPES registry on May 28, 2025.

Where is Domenick Fuller located?

Domenick Fuller practices at 921 S 8th Ave, Pocatello, ID 83209. The listed phone number is (208) 282-3289.

What is Domenick Fuller's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Domenick Fuller was last updated on June 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.