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Individual
DR. RICHARD N FACKO
Active
Individual
DR. RICHARD N FACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.028264
IL
1223P0221X
Pediatric Dentistry
Primary
021.002462
IL
Other
Enumeration date
03/01/2010
Last updated
07/05/2022
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