Individual
THOMAS SHOGO BACKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
503 NW 84TH CIR, VANCOUVER, WA 98665-7720
(360) 771-8987
Mailing address
503 NW 84TH CIR, VANCOUVER, WA 98665-7720
(360) 771-8987
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE60868304
WA
Other
Enumeration date
09/25/2018
Last updated
09/25/2018
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