Provider Demographics
NPI:1598922460
Name:ALPINE DENTISTRY
Entity Type:Organization
Organization Name:ALPINE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:T
Authorized Official - Last Name:STUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-756-3570
Mailing Address - Street 1:20 W MAIN STREET CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1889
Mailing Address - Country:US
Mailing Address - Phone:801-756-3570
Mailing Address - Fax:
Practice Address - Street 1:20 W MAIN STREET CT
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1889
Practice Address - Country:US
Practice Address - Phone:801-756-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2721939922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty