Healthcare Provider Details

I. General information

NPI: 1801432455
Provider Name (Legal Business Name): ALPINE DENTAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 S WADSWORTH BLVD STE 1778
LAKEWOOD CO
80227-3274
US

IV. Provider business mailing address

2323 S WADSWORTH BLVD STE 1778
LAKEWOOD CO
80227-3274
US

V. Phone/Fax

Practice location:
  • Phone: 303-980-4800
  • Fax:
Mailing address:
  • Phone: 303-980-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JUSTIN F BECERRA
Title or Position: MANAGER
Credential: DDS
Phone: 303-980-4800