Provider Demographics
NPI:1003910589
Name:SQUYRES, GARY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:SQUYRES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:514 HONEA EGYPT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3399
Mailing Address - Country:US
Mailing Address - Phone:281-252-8809
Mailing Address - Fax:281-252-8839
Practice Address - Street 1:514 HONEA EGYPT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3399
Practice Address - Country:US
Practice Address - Phone:281-252-8809
Practice Address - Fax:281-252-8839
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist