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General NPI Number Information
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NPI Number | 1245691492
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Entity Type | Organization
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Legal Business Name | DAVID R. BACKUS DDS, INC.
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 4720 JACKMAN RD SUITE A
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City | TOLEDO
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State | OH
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Zip | 43612-2077
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Country | US
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Telephone | 419-476-1484
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Fax | 419-476-6914
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Provider Business Mailing Address
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Address Line | 4720 JACKMAN RD SUITE A
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City | TOLEDO
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State | OH
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Zip | 43612-2077
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Country | US
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Telephone | 419-476-1484
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Fax | 419-476-6914
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Authorized Official
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Title or Position | TREASURER
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Name | AMY J BACKUS
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Credential |
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Telephone | 419-476-1484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 18187
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License Number State | OH
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