Provider Demographics
NPI:1477225845
Name:BENJAMIN R. SQUIRES, D.D.S.
Entity Type:Organization
Organization Name:BENJAMIN R. SQUIRES, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-233-6177
Mailing Address - Street 1:3308 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5758
Mailing Address - Country:US
Mailing Address - Phone:319-233-6177
Mailing Address - Fax:319-234-3906
Practice Address - Street 1:3308 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5758
Practice Address - Country:US
Practice Address - Phone:319-233-6177
Practice Address - Fax:319-234-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty