Nicholas R Backowski, D.M.D.
Individual provider Active NPI Dentist · Portland, OR
NPI 1457784555 · NPPES record last updated Dec 28, 2015
Key facts
- NPI
- 1457784555
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D9941 (OR)
- Practice address
- 2038 Lloyd Ctr
Portland, OR 97232-1309 - Phone
- (503) 288-5361
- NPI assigned
- Aug 13, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- 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 |
|---|---|---|---|---|
| I20160104000424 | OR | Order and Referring Only - Dentist |
7214239581 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D9941 | OR | Yes |
Addresses
Primary practice location
2038 Lloyd Ctr
Portland, OR 97232-1309
Mailing address
36840 Industrial Way B
Sandy, OR 97055-9254
Phone (503) 668-1300
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2015. 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.