Provider Demographics
NPI:1598994113
Name:EFTHYMIOU-BACKOS, STELLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:EFTHYMIOU-BACKOS
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 1:532 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-2129
Mailing Address - Country:US
Mailing Address - Phone:732-738-9087
Mailing Address - Fax:732-738-7371
Practice Address - Street 1:532 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2129
Practice Address - Country:US
Practice Address - Phone:732-738-9087
Practice Address - Fax:732-738-7371
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI169181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice