Provider Demographics
NPI:1861779522
Name:BACKES, DEBRA JEAN (RDH)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JEAN
Last Name:BACKES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:HEINKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:413 N. 17TH AVE.
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2910
Mailing Address - Country:US
Mailing Address - Phone:715-842-4649
Mailing Address - Fax:715-842-7331
Practice Address - Street 1:413 N. 17TH AVE.
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2910
Practice Address - Country:US
Practice Address - Phone:715-842-4649
Practice Address - Fax:715-842-7331
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3490-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist