DR. Brian C Back, D.M.D.

NPI #1053565218 in Mascoutah, Illinois

Provider Information

NPI Number: 1053565218
Entity Type: Individual
Name: DR. Brian C Back, D.M.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: D.M.D.
Enumeration Date: Nov 13, 2008
Last Updated: Jun 1, 2011

Practice Location

Address: 104 E MAIN ST
City: Mascoutah
State: Illinois
ZIP Code: 62258-2135
Phone: (618) 566-7384

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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