Provider Demographics
NPI:1972913200
Name:DR. TIMOTHY J. BACKIEWICZ, D.D.S., INC.
Entity Type:Organization
Organization Name:DR. TIMOTHY J. BACKIEWICZ, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BACKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-855-0202
Mailing Address - Street 1:68 N. HIGH ST.
Mailing Address - Street 2:BUILDING F
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054
Mailing Address - Country:US
Mailing Address - Phone:614-855-0202
Mailing Address - Fax:614-855-8520
Practice Address - Street 1:68 N. HIGH ST.
Practice Address - Street 2:BUILDING F
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054
Practice Address - Country:US
Practice Address - Phone:614-855-0202
Practice Address - Fax:614-855-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0195541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty