Provider Demographics
NPI:1235104175
Name:BACKMAN, RONALD G (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:BACKMAN
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2306
Mailing Address - Country:US
Mailing Address - Phone:845-735-2273
Mailing Address - Fax:845-735-2048
Practice Address - Street 1:71 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2306
Practice Address - Country:US
Practice Address - Phone:845-735-2273
Practice Address - Fax:845-735-2048
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0273841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice