Individual
DR. JACK FREDRICK BACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
154 STATE ROUTE 100 W, HERMANN, MO 65041-1526
(573) 486-3500
(573) 486-3166
Mailing address
154 STATE ROUTE 100 W, HERMANN, MO 65041-1526
(573) 486-3500
(573) 486-3166
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE 015082
MO
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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