Healthcare Provider Details

I. General information

NPI: 1669724068
Provider Name (Legal Business Name): BACKMAN COLIC & PATEL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9714 3RD AVE NE SUITE #203
SEATTLE WA
98115-2044
US

IV. Provider business mailing address

9714 3RD AVE NE SUITE #203
SEATTLE WA
98115-2044
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-1515
  • Fax: 206-524-1014
Mailing address:
  • Phone: 206-525-1515
  • Fax: 206-524-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number533769
License Number StateWA

VIII. Authorized Official

Name: SHERI A MAYER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 206-525-1515