MEDICARE: HEATHER BACKUES LDH

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	124Q00000X	Dental Hygienist	DH0000006739	TN

General Provider Information

NPI Number	:	1326293416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER BACKUES LDH

Provider Business Mailing Address
First Line	:	3326 ASPEN GROVE DR
Second Line	:	SUITE 120
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2837
Country	:	US
Telephone Number	:	615-771-2151
Fax Number	:	615-771-2161

Provider Business Practice Location Address
First Line	:	3326 ASPEN GROVE DR
Second Line	:	SUITE 120
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2837
Country	:	US
Telephone Number	:	615-771-2151
Fax Number	:	615-771-2161

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

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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