Individual provider · NPI-1

Dr. Jason Backus, DDS

Dentist, General Practice · Medford, OR

NPI number1770212409
StatusActive
Last updated in NPPESOct 1, 2025

Details

NPI
1770212409
Entity type
Individual (NPI-1)
Name
Dr. Jason Backus
Credential
DDS
Sex
Male
Sole proprietor
No
Enumeration date
Jun 8, 2022
Certification date
Oct 1, 2025
Last updated
Oct 1, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General PracticeD12169ORYes
122300000X Dentist12886440-9923UT
1223G0001X Dentist, General PracticeDEN.00205216CO

Other names

  • Jason Pruett (Former Name)

Practice location

11 Rossanley Dr
Medford, OR 97501-1713

Phone 541-797-6152

Mailing address

2794 High Cedars Ln
Medford, OR 97504-3416

Phone 801-245-0502

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Dentist, General Practice providers in Medford, OR