Todd L Squires DDC PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TODD L SQUIRES DDC PLLC

Practice address

2811 12TH Ave Rd
Nampa, ID 83686

Phone

(208) 466-2458

Fax

(208) 465-6303

NPI assigned

Apr 6, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Todd Lawrence Squires, DDS

Title

Owner

Phone

(801) 682-3097

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Southridge Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590537600000",
    "number": "1457593584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-466-2458",
            "fax_number": "208-465-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-466-2458",
            "fax_number": "208-465-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TODD L SQUIRES DDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A",
        "authorized_official_last_name": "SQUIRES",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-682-3097",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063894145",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southridge Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southridge Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Savannah Lynn Thurman, BS
• Daniel L Tiller, O.D.
• Titan Streamside Operator, LLC
• Mary Elisabeth Titmus, PA-C
• Diane E. Tobin, MNT
• Amanda Todd, BA
• Dennis Tofteland
• Amy Jewell Tolley
• Albert Stanton Tollinger, RPH
• Justin Tomal, M.D.

• General Practice Dentistry in Nampa, ID
• Providers in Nampa, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.