MEDICARE: DR. DEBORAH E BACKIEL DMD

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	031100	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	031100	OTHER	PA	LICENSE #

General Provider Information

NPI Number	:	1922087543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH E BACKIEL DMD

Provider Business Mailing Address
First Line	:	1500 JFK BLVD
Second Line	:	SUITE 300A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1721
Country	:	US
Telephone Number	:	267-514-8100
Fax Number	:	267-514-8102

Provider Business Practice Location Address
First Line	:	1500 JFK BLVD
Second Line	:	SUITE 300A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1721
Country	:	US
Telephone Number	:	267-514-8100
Fax Number	:	267-514-8102

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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