MEDICARE: SHELBY ALEXANDRA BACKMAN DDS

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	1223G0001X	General Practice Dentistry	00204888	CO

General Provider Information

NPI Number	:	1811665979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY ALEXANDRA BACKMAN DDS

Provider Business Mailing Address
First Line	:	5925 LEHMAN DR STE 5
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3418
Country	:	US
Telephone Number	:	719-634-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	5925 LEHMAN DR STE 5
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3418
Country	:	US
Telephone Number	:	719-634-0911
Fax Number	:

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

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	10/06/2021

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