# ROBERT L. FACKRELL DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fackrell Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801225180
- **Authorized official:** DR. ROBERT L FACKRELL DDS (PRESIDENT)
- **Authorized official phone:** (208) 233-2355

## Contact information

- **Practice address:** 415 N 3RD AVE STE A, POCATELLO, ID 83201-6306
- **Practice address phone:** (208) 233-2355
- **Practice address fax:** (208) 233-0582
- **Mailing address:** 415 N 3RD AVE STE A, POCATELLO, ID 83201-6306
- **Mailing address phone:** (208) 233-2355
- **Mailing address fax:** (208) 233-0582

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3134 | ID | Yes |

## Other

- **Enumeration date:** 11/06/2013
- **Last updated:** 01/13/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1215072798 | — | ID |