Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 21843 | TX |
NPI | 1003910589 |
---|---|
Provider Name | Dr. Gary Lee Squyres |
First Address | Magnolia, TX 77354-3399 |
Second Address | Magnolia, TX 77354-3399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 29/08/2014 |