Provider Demographics
NPI:1760465272
Name:BACKENSTOSE, THOMAS C JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:BACKENSTOSE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7 N COLUMBUS BLVD APT 238
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1421
Mailing Address - Country:US
Mailing Address - Phone:612-802-4697
Mailing Address - Fax:215-583-5222
Practice Address - Street 1:7 N COLUMBUS BLVD APT 238
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1421
Practice Address - Country:US
Practice Address - Phone:612-802-4697
Practice Address - Fax:215-583-5222
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108481223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics