Provider Demographics
NPI:1770633794
Name:FACTER, NORMAN ERNEST (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ERNEST
Last Name:FACTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231
Mailing Address - Country:US
Mailing Address - Phone:716-204-5838
Mailing Address - Fax:716-632-2963
Practice Address - Street 1:5178 CROFTON AVE
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1288
Practice Address - Country:US
Practice Address - Phone:440-349-2848
Practice Address - Fax:440-349-0848
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0169351223G0001X
OH16935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0513313Medicaid