Provider Demographics
NPI:1336986454
Name:BACKOFEN, CLAIRE (DMD)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:BACKOFEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4132
Mailing Address - Country:US
Mailing Address - Phone:318-865-2250
Mailing Address - Fax:
Practice Address - Street 1:318 CARROLL ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4132
Practice Address - Country:US
Practice Address - Phone:318-865-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist