Active NPI
Richard N Facko, DDS
- Pediatric Dentistry
- Palos Heights, IL
National Provider Identifier
1487977765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 021.002462
- Practice address
- 6446 W 127TH St
Palos Heights, IL 60463-2248 - Phone
- (708) 263-6708
- NPI assigned
- Mar 1, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.028264 | IL | |
| Pediatric Dentistry | 1223P0221X | 021.002462 | IL | Primary |
Addresses
Primary practice location
6446 W 127TH St
Palos Heights, IL 60463-2248
Mailing address
6446 W 127TH St
Palos Heights, IL 60463-2248
Phone (708) 263-6708
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.028264 | IL | MD | Dentist |
| 021.002462 | IL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1487977765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6446 W 127TH ST",
"city": "PALOS HEIGHTS",
"state": "IL",
"postal_code": "604632248",
"telephone_number": "708-263-6708",
"fax_number": "708-263-6707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6446 W 127TH ST",
"city": "PALOS HEIGHTS",
"state": "IL",
"postal_code": "604632248",
"telephone_number": "708-263-6708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FACKO",
"first_name": "RICHARD",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-01",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.028264",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IL",
"license": "021.002462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palos Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.