DR. ROBERT L FACKRELL DDS NPI 1215072798

NPI Information

NPI: 1215072798
Provider Name: DR. ROBERT L FACKRELL, DDS
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

Address:
415 N 3RD AVE STE A
POCATELLO, ID
ZIP 83201
Phone: (208) 233-2355
Get Directions

DR. Robert L Fackrell, DDS is a general practice dentist in Pocatello, ID. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Robert L Fackrell, DDS NPI is 1215072798. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

415 N 3RD AVE STE A
POCATELLO, ID
ZIP 83201-306
Phone: (208) 233-2355
Fax: (208) 233-0582

The enumeration date for this NPI number is 2/21/2007 and was last updated on 1/13/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	D3134	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	002783500	MEDICAID	IDAHO
2	000010010434	OTHER	IDAHO	BLUE CROSS
3	537818	OTHER	IDAHO	UNITED CONCORDIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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