Provider Demographics
NPI:1538292800
Name:BACKES, EDWARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:BACKES
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 1:1200 SE 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5032
Mailing Address - Country:US
Mailing Address - Phone:352-694-5280
Mailing Address - Fax:352-694-5280
Practice Address - Street 1:1200 SE 58TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5032
Practice Address - Country:US
Practice Address - Phone:352-694-5280
Practice Address - Fax:352-694-5280
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00099681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice