Provider Demographics
NPI:1669724068
Name:BACKMAN COLIC & PATEL PLLC
Entity type:Organization
Organization Name:BACKMAN COLIC & PATEL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-525-1515
Mailing Address - Street 1:9714 3RD AVE NE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2044
Mailing Address - Country:US
Mailing Address - Phone:206-525-1515
Mailing Address - Fax:206-524-1014
Practice Address - Street 1:9714 3RD AVE NE
Practice Address - Street 2:SUITE #203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2044
Practice Address - Country:US
Practice Address - Phone:206-525-1515
Practice Address - Fax:206-524-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5337691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty