Provider Demographics
NPI:1467566547
Name:BACKUS, DAVID READ (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:READ
Last Name:BACKUS
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 1:4720 JACKMAN RD.
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2030
Mailing Address - Country:US
Mailing Address - Phone:419-476-1484
Mailing Address - Fax:
Practice Address - Street 1:4720 JACKMAN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2030
Practice Address - Country:US
Practice Address - Phone:419-476-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181871223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist