Provider Demographics
NPI:1659449593
Name:FACKENTHAL, H MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:MICHAEL
Last Name:FACKENTHAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FIELDGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241
Mailing Address - Country:US
Mailing Address - Phone:412-833-0751
Mailing Address - Fax:
Practice Address - Street 1:107 NOBLE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205
Practice Address - Country:US
Practice Address - Phone:412-928-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA021369L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist