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General NPI Number Information
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NPI Number | 1306602875
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Entity Type | Organization
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Legal Business Name | RITTER & BACKSTROM DENTISTRY PLLC
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Dates
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Enumeration Date | 02/22/2024
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 2690 HIGHWAY 145
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City | SALTILLO
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State | MS
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Zip | 38866-6941
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Country | US
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Telephone | 662-869-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 726 HIGHLAND PARK DR
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City | TUPELO
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State | MS
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Zip | 38801-8901
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Country | US
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Telephone | 662-397-3749
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MILES ARTHUR BACKSTROM
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Credential | DMD
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Telephone | 662-397-3749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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