Provider Demographics
NPI:1659490878
Name:ALPINE DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:ALPINE DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOOISTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-732-8600
Mailing Address - Street 1:3096 W M32 HWY
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9753
Mailing Address - Country:US
Mailing Address - Phone:989-732-8600
Mailing Address - Fax:989-731-4937
Practice Address - Street 1:3096 W M32 HWY
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9753
Practice Address - Country:US
Practice Address - Phone:989-732-8600
Practice Address - Fax:989-731-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty