Provider Demographics
NPI:1083279814
Name:SQUIRES, TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SHANNON GLN
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9177
Mailing Address - Country:US
Mailing Address - Phone:585-200-7218
Mailing Address - Fax:
Practice Address - Street 1:175 EAST AVE
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1505
Practice Address - Country:US
Practice Address - Phone:585-639-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0617011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics