Provider Demographics
NPI:1003143413
Name:ALPINE SURGICAL ARTS, PC
Entity Type:Organization
Organization Name:ALPINE SURGICAL ARTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATE
Authorized Official - Middle Name:LOTT
Authorized Official - Last Name:VIEHWEG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-766-4834
Mailing Address - Street 1:3300 N RUNNING CREEK WAY
Mailing Address - Street 2:BUILDING H, SUITE 210
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043
Mailing Address - Country:US
Mailing Address - Phone:801-766-4834
Mailing Address - Fax:801-766-2315
Practice Address - Street 1:3300 N RUNNING CREEK WAY
Practice Address - Street 2:BUILDING H, SUITE 210
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:801-766-4834
Practice Address - Fax:801-766-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66328571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty