Provider Demographics
NPI:1922087543
Name:BACKIEL, DEBORAH E (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:E
Last Name:BACKIEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 JFK BLVD
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1721
Mailing Address - Country:US
Mailing Address - Phone:267-514-8100
Mailing Address - Fax:267-514-8102
Practice Address - Street 1:1500 JFK BLVD
Practice Address - Street 2:SUITE 300A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1721
Practice Address - Country:US
Practice Address - Phone:267-514-8100
Practice Address - Fax:267-514-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0311001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA031100OtherLICENSE #