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General NPI Number Information
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NPI Number | 1740768332
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Entity Type | Individual
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Provider Name | DR. MILES BACKSTROM
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Gender | Male
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 02/21/2024
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3990-18
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License Number State | MS
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