Provider Demographics
NPI:1164041935
Name:BACKENSTOSE, PAIGE (DDS)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BACKENSTOSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PINE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4901
Mailing Address - Country:US
Mailing Address - Phone:845-338-6900
Mailing Address - Fax:
Practice Address - Street 1:139 PINE ST STE 210
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4901
Practice Address - Country:US
Practice Address - Phone:845-338-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0607681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice