TODD L SQUIRES DDC PLLC (NPI# 1457593584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457593584 |
| Entity Type | Organization |
| Organization Name | TODD L SQUIRES DDC PLLC |
| Other Organization Name | SOUTHRIDGE DENTAL |
| Practice Address |
2811 12th Ave Rd Nampa ID 83686 |
| Practice Telephone | 2084662458 |
| Practice Fax Number | 2084656303 |
| Mailing Telephone | 2084662458 |
| Mailing Fax Number | 2084656303 |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2020-05-27 |
| Authorized Official Name | TODD LAWRENCE SQUIRES (OWNER) |
| Authorized Official Telephone | 8016823097 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1063894145 | 05 |
| Other Name | Type Code |
|---|---|
| Southridge Dental | Doing Business As Name - Organization |
| Street Address |
2811 12TH AVE RD |
| City | NAMPA |
| State | ID |
| Zip Code | 83686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508816000 | Roarke Jake Miller | Dentist | 2811 12th Ave Rd, Nampa, ID 83686 | 2006-05-12 |
| 1437660388 | Sleep Right Idaho Pllc | Dentist | 2811 12th Ave Rd, Nampa, ID 83686-8482 | 2017-10-18 |
| 1063894145 | Todd Squires | Dentist | 2811 12th Ave Rd, Nampa, ID 83686-8482 | 2015-06-24 |
| 1962714139 | Shawn D Lee | Dentist | 2811 12th Ave Rd, Nampa, ID 83686-8482 | 2010-07-05 |
| 1891954343 | Southridge Dental | Dentist | 2811 12th Ave Rd, Nampa, ID 83686-8482 | 2008-06-09 |
| 1689849598 | Kelly E. Carlen, Dds Pllc | Clinic/Center | 2811 12th Ave Rd, Nampa, ID 83686-8482 | 2008-04-23 |
| 1053503573 | Kelly E Carlen | Dentist | 2811 12th Ave Rd, Nampa, ID 83686-8482 | 2007-08-17 |
| 1003010877 | Southridge Dental | Dentist | 2811 12th Ave Rd, Nampa, ID 83686-8482 | 2007-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184255960 | Kristine Lynn Fitts-eisenbrandt | Social Worker | 270 W. Gerogia Ave., Nampa, ID 83686 | 2020-01-30 |
| 1669025706 | Vitality Family Chiropractic, Pllc | Chiropractor | 3189 E Greenhurst Rd, Nampa, ID 83686 | 2019-07-18 |
| 1871150185 | King's Peak Investments, Inc. | Substance Abuse Rehabilitation Facility | 8898 Idaho 45, Nampa, ID 83686 | 2019-05-22 |
| 1154805786 | Jmj Nampa LLC | Dentist | 914 12th Ave Rd, Nampa, ID 83686 | 2018-09-19 |
| 1518448703 | Michel Cox | Pharmacy Technician | 2219 12th Ave S, Nampa, ID 83686 | 2018-08-24 |
| 1437504909 | 5 Peppers Inc | Family Medicine | 217 W. Georgia Ave. Ste 120, Nampa, ID 83686 | 2016-05-03 |
| 1811369549 | Anna Stoia | Physician Assistant | 4401 E. Tuscany Ave., Nampa, ID 83686 | 2015-10-21 |
| 1144699307 | Jamie Green | Social Worker | 112 12th Avenue Rd., Nampa, ID 83686 | 2015-09-17 |
| 1174927933 | Bower Chiropractic Inc | Chiropractor | 304 12th Ave Rd, Nampa, ID 83686 | 2014-10-22 |
| 1285037093 | Rosemary Phelps | Registered Nurse | 353 W. Iowa, Nampa, ID 83686 | 2014-10-07 |
| Find all providers in zip 83686 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598254336 | Ns and Associates Pllc | Dentist | 16375 N Merchant Way, Nampa, ID 83687-5380 | 2018-05-08 |
| 1891122776 | Bradford B. Fisher Dentistry, Pllc | Dentist | 207 7th Ave S, Nampa, ID 83651-3846 | 2013-10-09 |
| 1619302080 | David Lyle Farris | Dentist | 16548 North Franklin Blvd., Nampa, ID 83687 | 2013-09-04 |
| 1992938674 | William Chad Wolff | Dentist | 5550 East Franklin Road, Nampa, ID 83687-7910 | 2009-08-28 |
| 1609003466 | Andrew A Thuernagle | Dentist | 3161 E Greenhurst Rd, Nampa, ID 83686-8655 | 2009-06-18 |
| 1891921052 | Idaho Dental Aid, Pllc | Dentist | 604 3rd St S, Nampa, ID 83651-3840 | 2009-06-02 |
| 1285884056 | Aspen Creek Dental Pllc | Dentist | 6144 Birch Ln, Nampa, ID 83687-4148 | 2008-09-29 |
| 1972764058 | Awp Dental Group | Dentist | 16377 N Market Place Blvd, Nampa, ID 83687-7910 | 2008-06-20 |
| 1902077001 | Gentle Dental Care Pllc | Dentist | 1601 12th Ave Rd Ste 103, Nampa, ID 83686-6185 | 2008-03-17 |
| 1205958899 | Scott Hiromi Kido | Dentist | 341 W Iowa Ave, Nampa, ID 83686-2856 | 2007-04-04 |
| Find all providers in NAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.