Healthcare Provider Details

I. General information

NPI: 1770633794
Provider Name (Legal Business Name): NORMAN ERNEST FACTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5178 CROFTON AVE
SOLON OH
44139-1288
US

IV. Provider business mailing address

PO BOX 316
WILLIAMSVILLE NY
14231
US

V. Phone/Fax

Practice location:
  • Phone: 440-349-2848
  • Fax: 440-349-0848
Mailing address:
  • Phone: 716-204-5838
  • Fax: 716-632-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number16935
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.016935
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: