Individual
DR. BRIAN C BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
104 E MAIN ST, MASCOUTAH, IL 62258-2135
(618) 566-7384
(618) 566-4290
Mailing address
104 E MAIN ST, P.O. BOX 142, MASCOUTAH, IL 62258-2135
(618) 566-7384
(618) 566-4290
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027792
IL
Other
Enumeration date
11/13/2008
Last updated
06/01/2011
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