| Fackrell Family Dentistry | |
|
415 N 3rd Ave Ste A Pocatello ID 83201-6306 | |
| (208) 233-2355 | |
| (208) 233-0582 |
| Full Name | Fackrell Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 415 N 3rd Ave Ste A, Pocatello, Idaho |
| Authorized Official Name and Position | Robert L Fackrell (PRESIDENT) |
| Authorized Official Contact | 2082332355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fackrell Family Dentistry 415 N 3rd Ave Ste A Pocatello ID 83201-6306 Ph: (208) 233-2355 | Fackrell Family Dentistry 415 N 3rd Ave Ste A Pocatello ID 83201-6306 Ph: (208) 233-2355 |
| NPI Number | 1801225180 |
|---|---|
| Provider Enumeration Date | 11/06/2013 |
| Last Update Date | 01/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801225180 | NPI | - | NPPES |
| 1215072798 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D3134 (Idaho) | Primary |
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