Individual
JONATHAN E BACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1551 E MAIN ST, COTTAGE GROVE, OR 97424-2241
(541) 942-8437
(541) 942-1350
Mailing address
1551 E MAIN ST, COTTAGE GROVE, OR 97424-2241
(541) 942-8437
(541) 942-1350
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D7805
OR
1223G0001X
General Practice Dentistry
Primary
D7805
OR
Other
Enumeration date
11/27/2006
Last updated
01/09/2019
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