ROBERT L. FACKRELL DDS PA (NPI# 1801225180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801225180 |
| Entity Type | Organization |
| Organization Name | ROBERT L. FACKRELL DDS PA |
| Other Organization Name | FACKRELL FAMILY DENTISTRY |
| 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 | 2013-11-06 |
| Last Update Date | 2015-01-13 |
| Authorized Official Name | DR. ROBERT L FACKRELL (PRESIDENT) |
| Authorized Official Telephone | 2082332355 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | D3134 | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1215072798 | 05 |
| Other Name | Type Code |
|---|---|
| Fackrell Family Dentistry | Doing Business As Name - Organization |
| Street Address |
415 N 3RD AVE STE A |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-6306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215072798 | Robert L Fackrell | Dentist | 415 N 3rd Ave Ste A, Pocatello, ID 83201-6306 | 2007-02-21 |
| 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 | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649619933 | Michael George | Dentist | 485 E Alameda Rd, Pocatello, ID 83201-3609 | 2013-06-19 |
| 1356643308 | Blackrock Dental Partners, Pllc | Dentist | 1606 E. Center St., Pocatello, ID 83201-4007 | 2010-11-24 |
| 1881810281 | Johnson & Snow Dental, Pa | Dentist | 1606 E Center St, Pocatello, ID 83201-4007 | 2007-04-17 |
| 1093876328 | William Jared Terry | Dentist | 2318 Douglas St, Pocatello, ID 83201-1851 | 2006-12-12 |
| 1386716041 | Lee R. Reddish | Dentist | 1980 Birdie Thompson Dr, Pocatello, ID 83201-2755 | 2006-11-15 |
| 1023194206 | Duane J Williams | Dentist | 1130 Call Creek Drive, Pocatello, ID 83201 | 2006-10-31 |
| 1477667335 | Gregory E Romriell | Dentist | 675 Yellowstone Ave Ste E, Pocatello, ID 83201-4511 | 2006-08-18 |
| 1154939619 | Julia Krek | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2020-07-21 |
| 1598382251 | Andrew Ringle | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2020-06-29 |
| 1093331076 | John Andrew Haslam | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2020-06-24 |
| 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.