Provider Demographics
NPI:1578716148
Name:ALPINE DENTISTRY
Entity Type:Organization
Organization Name:ALPINE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-445-8896
Mailing Address - Street 1:1620 ALPINE BLVD.
Mailing Address - Street 2:SU. #121
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901
Mailing Address - Country:US
Mailing Address - Phone:619-445-8896
Mailing Address - Fax:619-445-7339
Practice Address - Street 1:1620 ALPINE BLVD.
Practice Address - Street 2:SU. #121
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901
Practice Address - Country:US
Practice Address - Phone:619-445-8896
Practice Address - Fax:619-445-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29162122300000X
CA47454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty