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Organization
TODD L SQUIRES DDC PLLC
Active
Organization
TODD L SQUIRES DDC PLLC
Active
Other names
Southridge Dental
Organization subpart
No
Provider details
NPI number
Authorized official
TODD LAWRENCE SQUIRES DDS (OWNER)
(801) 682-3097
Entity
Organization
Contact information
Practice address
2811 12TH AVE RD, NAMPA, ID 83686
(208) 466-2458
(208) 465-6303
Mailing address
2811 12TH AVE RD, NAMPA, ID 83686
(208) 466-2458
(208) 465-6303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063894145
—
ID
Enumeration date
04/06/2009
Last updated
05/27/2020
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