Healthcare Provider Details

I. General information

NPI: 1467566547
Provider Name (Legal Business Name): DAVID READ BACKUS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 JACKMAN RD
TOLEDO OH
43612-2030
US

IV. Provider business mailing address

4720 JACKMAN RD.
TOLEDO OH
43612-2030
US

V. Phone/Fax

Practice location:
  • Phone: 419-476-1484
  • Fax:
Mailing address:
  • Phone: 419-476-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number18187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: