Provider Demographics
NPI:1467992149
Name:GREATER CHATTANOOGA ORTHODONTICS
Entity Type:Organization
Organization Name:GREATER CHATTANOOGA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:423-296-0407
Mailing Address - Street 1:1829 GUNBARREL RD
Mailing Address - Street 2:STE. B
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7184
Mailing Address - Country:US
Mailing Address - Phone:423-296-0407
Mailing Address - Fax:423-296-0174
Practice Address - Street 1:1829 GUNBARREL RD
Practice Address - Street 2:STE. B
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7184
Practice Address - Country:US
Practice Address - Phone:423-296-0407
Practice Address - Fax:423-296-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY94311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007710Medicaid
GA003140827AMedicaid