Provider Demographics
NPI:1386252021
Name:SQUIRE, MADISON ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:ANN
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 BENDIX ROAD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-499-9639
Mailing Address - Fax:757-480-2288
Practice Address - Street 1:272 BENDIX RD.
Practice Address - Street 2:SUITE 650
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-499-9639
Practice Address - Fax:757-480-2288
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014170381223G0001X
VA040147038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice