Fackrell, Robert L

Fackrell, Robert L is an sole proprietor health care provider with primary practice located at 415 N 3Rd Ave Ste A , Pocatello ID 83201-6306. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Fackrell, Robert L can be contacted via phone (208) 233-2355.

Contact Information

Primary practice address
415 N 3Rd Ave Ste A Pocatello ID 83201-6306
Phone: (208) 233-2355
Fax: (208) 233-0582
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D3134 Idaho

Profile Details

NPI number 1215072798
LBN Legal business name Fackrell, Robert L
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 21st, 2007
Last updated Jan 13th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215072798 NPPES
Idaho Other 537818 UNITED CONCORDIA
Idaho Other 000010010434 UNITED CONCORDIA
Idaho MEDICAID 002783500 UNITED CONCORDIA

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