MEDICARE: DR. JOHN PAUL BACKMEYER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	6369	IN

General Provider Information

NPI Number	:	1285639872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL BACKMEYER D.D.S.

Provider Business Mailing Address
First Line	:	888 SIM HODGIN PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	765-935-4519
Fax Number	:	765-939-9701

Provider Business Practice Location Address
First Line	:	888 SIM HODGIN PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1931
Country	:	US
Telephone Number	:	765-935-4519
Fax Number	:	765-939-9701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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