Debra Jean Backes, R.D.H. – Dental Hygienist

Key facts

NPI: 1861779522
Entity type: Individual (NPI type 1)
Primary specialty: Dental Hygienist 124Q00000X
License: 3490-16 (WI)
Practice address: 413 N. 17TH Ave.
Wausau, WI 54401-2910
Phone: (715) 842-4649
Fax: (715) 842-7331
NPI assigned: Nov 9, 2011
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
3490-16	WI	MD	Dental Hygienist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dental Hygienist	124Q00000X	3490-16	WI	Yes

Addresses

Primary practice location

413 N. 17TH Ave.
Wausau, WI 54401-2910

Mailing address

413 N. 17TH Ave.
Wausau, WI 54401-2910
Phone (715) 842-4649

Other names

Miss Debra Jean Heinkel Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 9, 2011.

{
    "created_epoch": "1320796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1861779522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 N. 17TH AVE.",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012910",
            "telephone_number": "715-842-4649",
            "fax_number": "715-842-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 N. 17TH AVE.",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012910",
            "telephone_number": "715-842-4649",
            "fax_number": "715-842-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACKES",
        "first_name": "DEBRA",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "R.D.H.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-09",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "WI",
            "license": "3490-16",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "HEINKEL",
            "middle_name": "JEAN",
            "prefix": "MISS",
            "credential": "R.D.H.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wausau, WI

All providers in Wausau, WI · Dental Hygienist in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.