| NPI | 1801225180 |
|---|---|
| Doing Business As | FACKRELL FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | ROBERT L FACKRELL President 208-233-2355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3134) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2015-01-13 |