DR. ROBERT L FACKRELL (NPI# 1215072798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215072798 |
| Entity Type | Individual |
| Full Name | DR. ROBERT L FACKRELL |
| Credential | DDS |
| Practice Address |
415 N 3rd Ave Ste A Pocatello ID 83201-6306 |
| Practice Telephone | 2082332355 |
| Practice Fax Number | 2082330582 |
| Mailing Telephone | 2082332355 |
| Mailing Fax Number | 2082330582 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2015-01-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D3134 | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE CROSS | 000010010434 | 01 |
| ID | 002783500 | 05 | |
| ID | UNITED CONCORDIA | 537818 | 01 |
| Street Address |
415 N 3RD AVE STE A |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-6306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801225180 | Robert L. Fackrell Dds Pa | Dentist | 415 N 3rd Ave Ste A, Pocatello, ID 83201-6306 | 2013-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982119459 | Good Blood Pllc | Dentist | 4165 Yellowstone Ave, Pocatello, ID 83202-2414 | 2017-12-06 |
| 1952822686 | Connor Fairbanks | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2017-07-03 |
| 1326281163 | Care Creek Dental LLC | Dentist | 1169 Call Creek Dr Ste A, Pocatello, ID 83201-3077 | 2009-04-09 |
| 1306005236 | Olympus Family Dental | Dentist | 1598 Delphic Way Ste B, Pocatello, ID 83201-2200 | 2008-06-05 |
| 1730348806 | Call Family Dentistry | Dentist | 1352 E Center St Ste B, Pocatello, ID 83201-4769 | 2008-06-04 |
| 1215102439 | Four Season Dental PC | Dentist | 115 E Chapel Rd, Pocatello, ID 83201 | 2008-04-29 |
| 1174797716 | Carl B. Holm, D.d.s., P.C. | Dentist | 350 E Cedar St, Suite A, Pocatello, ID 83201-3709 | 2008-04-15 |
| 1790999407 | Allied Dental Clinic, PC | Dentist | 1246 Yellowstone Ave Ste B3, Pocatello, ID 83201-4372 | 2007-05-10 |
| 1205957594 | Mary Allison Harper | Dentist | 465 Memorial Dr., Pocatello, ID 83209-8088 | 2007-04-03 |
| 1043362452 | Carl B Holm | Dentist | 350 E Cedar St Ste A, Pocatello, ID 83201-3709 | 2007-01-17 |
| Find all providers in POCATELLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.