MEDICARE: DR. TIMOTHY J. BACKIEWICZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19554	OH

General Provider Information

NPI Number	:	1952422420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY J. BACKIEWICZ D.D.S.

Provider Business Mailing Address
First Line	:	7284 HAMPTON HILLS LN
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-8307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 N HIGH ST
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-8532
Country	:	US
Telephone Number	:	614-855-0202
Fax Number	:	614-855-8520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. TIMOTHY J. BACKIEWICZ D.D.S.” Practice Location

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