Healthcare Provider Details

I. General information

NPI: 1871417964
Provider Name (Legal Business Name): THOMAS BACKUS DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 SE MILL PLAIN BLVD STE 106
VANCOUVER WA
98684-5089
US

IV. Provider business mailing address

11818 SE MILL PLAIN BLVD STE 106
VANCOUVER WA
98684-5089
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-5150
  • Fax:
Mailing address:
  • Phone: 360-896-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS BACKUS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 360-771-8987