Provider Demographics
NPI:1306172960
Name:ASPIRE ORTHODONTICS, PC
Entity type:Organization
Organization Name:ASPIRE ORTHODONTICS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GREY
Authorized Official - Last Name:WEATHERSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:423-238-1494
Mailing Address - Street 1:5913 OOLTEWAH RINGGOLD RD # 103
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7809
Mailing Address - Country:US
Mailing Address - Phone:423-238-1494
Mailing Address - Fax:423-238-1495
Practice Address - Street 1:5913 OOLTEWAH RINGGOLD RD # 103
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7809
Practice Address - Country:US
Practice Address - Phone:423-238-1494
Practice Address - Fax:423-238-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25611223X0400X
TN81311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515343Medicaid
TN3207077OtherTENNCARE
TN5441630OtherTENNCARE