Individual
DR. MITCHELL TIMOTHY FACKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
968 1ST INFANTRY DIVISION RD, FORT KNOX, KY 40121-5210
(502) 626-8314
Mailing address
5879 ADAMS ST # A, FORT KNOX, KY 40121-4001
(502) 626-8314
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901601406
MI
Other
Enumeration date
07/12/2022
Last updated
04/19/2023
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