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General NPI Number Information
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NPI Number | 1306172960
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Entity Type | Organization
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Legal Business Name | ASPIRE ORTHODONTICS, PC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 5913 OOLTEWAH RINGGOLD RD # 103
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City | OOLTEWAH
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State | TN
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Zip | 37363-7809
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Country | US
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Telephone | 423-238-1494
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Fax | 423-238-1495
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Provider Business Mailing Address
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Address Line | 5913 OOLTEWAH RINGGOLD RD # 103
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City | OOLTEWAH
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State | TN
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Zip | 37363-7809
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Country | US
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Telephone | 423-238-1494
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Fax | 423-238-1495
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Authorized Official
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Title or Position | SHAREHOLDER
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Name | DR. MICHAEL GREY WEATHERSBY
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Credential | DDS, MDS
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Telephone | 423-238-1494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2561
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8131
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License Number State | TN
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