Provider Demographics
NPI:1114194867
Name:BACKIEWICZ, BARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:BACKIEWICZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WATERBURY CT
Mailing Address - Street 2:STE B
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-476-5300
Mailing Address - Fax:614-476-5593
Practice Address - Street 1:465 WATERBURY CT
Practice Address - Street 2:STE B
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5312
Practice Address - Country:US
Practice Address - Phone:614-476-5300
Practice Address - Fax:614-476-5593
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18338122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist