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General NPI Number Information
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NPI Number | 1457593584
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Entity Type | Organization
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Legal Business Name | TODD L SQUIRES DDC PLLC
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 2811 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-466-2458
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Fax | 208-465-6303
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Provider Business Mailing Address
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Address Line | 2811 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-466-2458
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Fax | 208-465-6303
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Authorized Official
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Title or Position | OWNER
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Name | TODD LAWRENCE SQUIRES
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Credential | DDS
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Telephone | 801-682-3097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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