Provider Demographics
NPI:1225163041
Name:BACKMAN, CHARLES A (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:BACKMAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 77TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4864
Mailing Address - Country:US
Mailing Address - Phone:206-230-7798
Mailing Address - Fax:206-232-3286
Practice Address - Street 1:9714 3RD AVE NE
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2044
Practice Address - Country:US
Practice Address - Phone:206-525-1515
Practice Address - Fax:206-524-1014
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics