Organization
ROBERT L. FACKRELL DDS PA
Active
Other names
Fackrell Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT L FACKRELL DDS (PRESIDENT)
(208) 233-2355
Entity
Organization
Contact information
Practice address
415 N 3RD AVE STE A, POCATELLO, ID 83201-6306
(208) 233-2355
(208) 233-0582
Mailing address
415 N 3RD AVE STE A, POCATELLO, ID 83201-6306
(208) 233-2355
(208) 233-0582
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3134
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215072798
—
ID
Enumeration date
11/06/2013
Last updated
01/13/2015
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