Jack Fredrick Backs, D.M.D.
Individual provider Active NPI General Practice Dentistry · Hermann, MO
NPI 1104046556 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104046556
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DE 015082 (MO)
- Practice address
- 154 State Route 100 W
Hermann, MO 65041-1526 - Phone
- (573) 486-3500
- Fax
- (573) 486-3166
- NPI assigned
- Apr 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150602000185 | MO | Order and Referring Only - Dentist |
9830410950 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE 015082 | MO | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE 015082 | MO | Yes |
Addresses
Primary practice location
154 State Route 100 W
Hermann, MO 65041-1526
Mailing address
154 State Route 100 W
Hermann, MO 65041-1526
Phone (573) 486-3500
Other providers in Hermann, MO
- 1St Unity CDS Home Care LLC
- Jennifer A Allen
- Americare at Victorian Manor of Hermann, LLC
- John Earl Bader Jr.
- Laurel L Baumstark
- Jennifer L Blair
- Barbara Dale Carr
- Emmogene Lee Chepely
All providers in Hermann, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.