Healthcare Provider Details

I. General information

NPI: 1134789845
Provider Name (Legal Business Name): ALPINE SURGICAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S 11TH ST STE 300
BOISE ID
83702-6968
US

IV. Provider business mailing address

403 S 11TH ST STE 300
BOISE ID
83702-6968
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-9115
  • Fax: 208-344-9113
Mailing address:
  • Phone: 208-344-9115
  • Fax: 208-344-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARMAN HAGHIGHI
Title or Position: OWNER
Credential: DDS
Phone: 208-344-9115