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General NPI Number Information
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NPI Number | 1477225845
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Entity Type | Organization
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Legal Business Name | BENJAMIN R. SQUIRES, D.D.S.
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 3308 KIMBALL AVE
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City | WATERLOO
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State | IA
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Zip | 50702-5758
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Country | US
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Telephone | 319-233-6177
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Fax | 319-234-3906
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Provider Business Mailing Address
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Address Line | 3308 KIMBALL AVE
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City | WATERLOO
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State | IA
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Zip | 50702-5758
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Country | US
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Telephone | 319-233-6177
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Fax | 319-234-3906
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN ROBERT SQUIRES
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Credential |
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Telephone | 319-233-6177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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