Mark Joseph Squicquero, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30-016337 Issued in OH

Practice address

567 E Main St
Canfield, OH 44406-1547

Phone

(330) 533-1153

Fax

(330) 533-6745

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 7, 2013 through Nov 7, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tri-County Physical Therapy Institute LLC

  • Physical Therapist
  • Canfield, OH
  • NPI 1225544307
  NPD (past)
• Tri-County Rehabilitation Inc.

  • Physical Therapist
  • Canfield, OH
  • NPI 1902086747
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932255759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 E MAIN ST",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444061547",
            "telephone_number": "330-533-1153",
            "fax_number": "330-533-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 E MAIN ST",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444061547",
            "telephone_number": "330-533-1153",
            "fax_number": "330-533-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SQUICQUERO",
        "first_name": "MARK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-016337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Ann Solmen, MSW
• Diane Soltis, OTR/L
• Dennis Sopkovich
• South Range Local School District
• Megan R Spitz, MD
• Dorothea Jean Stanley, LISW
• Amy Stanovcak, RN
• Mark Stein, BCBA
• Gina Marie Stephenson
• Connie Stewart, LPN

• General Practice Dentistry in Canfield, OH
• Providers in Canfield, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.