Provider Demographics
NPI:1801959804
Name:BACKHAUS, MICHELLE M (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:BACKHAUS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:176 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4908
Mailing Address - Country:US
Mailing Address - Phone:732-257-5588
Mailing Address - Fax:732-257-9189
Practice Address - Street 1:176 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4908
Practice Address - Country:US
Practice Address - Phone:732-257-5588
Practice Address - Fax:732-257-9189
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ22DI022920001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry