Provider Demographics
NPI:1659917094
Name:ALPINE DENTAL SERVICES LINCOLN, PLLC
Entity Type:Organization
Organization Name:ALPINE DENTAL SERVICES LINCOLN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-980-4800
Mailing Address - Street 1:12501 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4753
Mailing Address - Country:US
Mailing Address - Phone:303-768-8137
Mailing Address - Fax:
Practice Address - Street 1:12501 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4753
Practice Address - Country:US
Practice Address - Phone:303-768-8137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental