Healthcare Provider Details

I. General information

NPI: 1205115193
Provider Name (Legal Business Name): ALPINE DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 N 5500 W STE 200
HIGHLAND UT
84003-9646
US

IV. Provider business mailing address

11020 N 5500 W STE 200
HIGHLAND UT
84003-9646
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-4440
  • Fax: 801-756-4440
Mailing address:
  • Phone: 801-756-4440
  • Fax: 801-756-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4748626
License Number StateUT

VIII. Authorized Official

Name: KATELYN MITCHELL
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 385-224-2794