Healthcare Provider Details

I. General information

NPI: 1770302390
Provider Name (Legal Business Name): KUDZAI CHIKWAWA DDS LLC ASPIRE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 BRAINERD RD
CHATTANOOGA TN
37411-3847
US

IV. Provider business mailing address

4727 BRAINERD RD
CHATTANOOGA TN
37411-3847
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-4869
  • Fax: 423-622-4875
Mailing address:
  • Phone: 423-622-4869
  • Fax: 423-622-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KUDZAI CHIKWAVA
Title or Position: DDS
Credential:
Phone: 423-622-4869