Active NPI
Shannon M. Backofen, DDS
- Pediatric Dentistry
- Shreveport, LA
National Provider Identifier
1306075718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 4600
- Practice address
- 318 Carroll St
Shreveport, LA 71105-4132 - Phone
- (318) 865-2250
- Fax
- (318) 865-3751
- NPI assigned
- Jul 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 4600 | LA | Primary |
Addresses
Primary practice location
318 Carroll St
Shreveport, LA 71105-4132
Mailing address
318 Carroll St
Shreveport, LA 71105-4132
Phone (318) 865-2250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4600 | LA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246924800000",
"number": "1306075718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "318 CARROLL ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711054132",
"telephone_number": "318-865-2250",
"fax_number": "318-865-3751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "318 CARROLL ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711054132",
"telephone_number": "318-865-2250",
"fax_number": "318-865-3751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACKOFEN",
"first_name": "SHANNON",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-07",
"last_updated": "2009-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "LA",
"license": "4600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.