Provider Demographics
NPI:1619544749
Name:HARRY SQUIRE
Entity Type:Organization
Organization Name:HARRY SQUIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:WOOTEN
Authorized Official - Last Name:SQUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-594-7453
Mailing Address - Street 1:516 INNOVATION DR STE 302
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3866
Mailing Address - Country:US
Mailing Address - Phone:757-436-0026
Mailing Address - Fax:
Practice Address - Street 1:516 INNOVATION DR STE 302
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3866
Practice Address - Country:US
Practice Address - Phone:757-436-0026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty