Provider Demographics
NPI:1700445145
Name:SQUIRE, HARRY WOOTEN (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:WOOTEN
Last Name:SQUIRE
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 1:516 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:757-547-5658
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:757-547-5658
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice