Provider Demographics
NPI:1003634338
Name:NEW HEIGHTS DENTISTRY LLC
Entity type:Organization
Organization Name:NEW HEIGHTS DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-433-9305
Mailing Address - Street 1:3015 WEATHERTON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2723
Mailing Address - Country:US
Mailing Address - Phone:859-433-9305
Mailing Address - Fax:
Practice Address - Street 1:4704 CAHABA RIVER RD STE 2D
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2344
Practice Address - Country:US
Practice Address - Phone:205-262-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental