Southridge Dental
LBN: Todd L Squires Ddc Pllc
Southridge Dental is an health care organization with primary practice located at 2811 12Th Ave Rd , Nampa ID 83686. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Ambulatory Health Care Facilities / Dental. Dental Providers / General Practice is the primary health care specialty.
Todd L Squires Ddc Pllc can be contacted via phone (208) 466-2458, or through Squires, Todd Lawrence via phone (801) 682-3097.
Contact Information
Primary practice address
2811 12Th Ave Rd
Nampa ID 83686
Phone: (208) 466-2458
Fax: (208) 465-6303
Website:
Authorized official contact:
Name: Squires, Todd Lawrence Doctor of Dental Surgery (DDS)
Phone: (801) 682-3097
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | ||
| Ambulatory Health Care Facilities / Dental | 261QD0000X |
Profile Details
| NPI number | 1457593584 |
|---|---|
| LBN Legal business name | Todd L Squires Ddc Pllc |
| DBA Doing business as | Southridge Dental |
| Authorized official | Squires, Todd Lawrence Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 6th, 2009 |
| Last updated | May 27th, 2020 - about 6 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457593584 | NPPES |
| Idaho | MEDICAID | 1063894145 |
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