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General NPI Number Information
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NPI Number | 1295300184
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Entity Type | Individual
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Provider Name | BRITTANY SQUIRES
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Gender | Female
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 410 SPRING FOREST RD
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City | GREENVILLE
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State | NC
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Zip | 27834-7244
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Country | US
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Telephone | 252-650-5774
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Fax | 252-516-7040
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Provider Business Mailing Address
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Address Line | 608 VILLA GRANDE DR
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City | WINTERVILLE
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State | NC
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Zip | 28590-8072
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Country | US
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Telephone | 252-702-5838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12388
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License Number State | NC
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