Organization Name: | DR. THOMAS BACKENSTOSE DMD |
NPI Number: | 1033372412 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS CECIL BACKENSTOSE (PRESIDENT) |
Mailing Address: | 504 2nd Ave S Saint James |
State: | MN US |
Postal Code: | 560811737 |
Phone Number: | 5073754611 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2008 |
NPI Last Update Date: | 07/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | D10848 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |