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General NPI Number Information
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NPI Number | 1770212409
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Entity Type | Individual
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Provider Name | JASON BACKUS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 11 ROSSANLEY DR
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City | MEDFORD
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State | OR
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Zip | 97501-1713
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Country | US
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Telephone | 541-797-6152
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Fax |
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Provider Business Mailing Address
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Address Line | 2794 HIGH CEDARS LN
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City | MEDFORD
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State | OR
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Zip | 97504-3416
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Country | US
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Telephone | 801-245-0502
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12886440-9923
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00205216
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12169
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License Number State | OR
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