Provider Demographics
NPI:1891841649
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
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:
Authorized Official - Phone:716-439-1877
Mailing Address - Street 1:1705 PINE AVENUE
Mailing Address - Street 2:FL. 1
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-284-0110
Mailing Address - Fax:716-284-0046
Practice Address - Street 1:1705 PINE AVENUE
Practice Address - Street 2:FL 1
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-284-0110
Practice Address - Fax:716-284-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
NY04465921223G0001X
NY050094-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03162109Medicaid
NY02768523Medicaid