Provider Demographics
NPI:1790920478
Name:ASPIRE FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:ASPIRE FAMILY DENTAL, PLLC
Other - Org Name:ASPIRE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-439-1877
Mailing Address - Street 1:484 ONTARIO STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207
Mailing Address - Country:US
Mailing Address - Phone:716-873-0681
Mailing Address - Fax:716-995-2956
Practice Address - Street 1:484 ONTARIO STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207
Practice Address - Country:US
Practice Address - Phone:716-873-0681
Practice Address - Fax:716-995-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03162109Medicaid