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General NPI Number Information
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NPI Number | 1497251961
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Entity Type | Individual
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Provider Name | MICHELLE FACKLER DMD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 11/20/2021
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Provider Practice Location Address
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Address Line | 375 FULTON ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-3454
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Country | US
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Telephone | 516-249-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 19 ROBERTA LN
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City | COMMACK
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State | NY
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Zip | 11725-3815
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Country | US
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Telephone | 516-661-5295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 069155
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License Number State | NY
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