Provider Demographics
NPI:1871253328
Name:ALPEN IMPLANTS AND PERIODONTICS SPECIALISTS LLC
Entity Type:Organization
Organization Name:ALPEN IMPLANTS AND PERIODONTICS SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THUNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-783-6249
Mailing Address - Street 1:4252 S HIGHLAND DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2684
Mailing Address - Country:US
Mailing Address - Phone:801-783-6249
Mailing Address - Fax:
Practice Address - Street 1:3397 N 1200 E STE 111
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3262
Practice Address - Country:US
Practice Address - Phone:801-766-6966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty