Provider Demographics
NPI:1134789845
Name:ALPINE SURGICAL ARTS LLC
Entity type:Organization
Organization Name:ALPINE SURGICAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-344-9115
Mailing Address - Street 1:403 S 11TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6968
Mailing Address - Country:US
Mailing Address - Phone:208-344-9115
Mailing Address - Fax:208-344-9113
Practice Address - Street 1:403 S 11TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6968
Practice Address - Country:US
Practice Address - Phone:208-344-9115
Practice Address - Fax:208-344-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery