Healthcare Provider Details

I. General information

NPI: 1306489059
Provider Name (Legal Business Name): ALPINE DENTISTS AND SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W MAIN STREET CT STE 100
ALPINE UT
84004-1889
US

IV. Provider business mailing address

20 W MAIN STREET CT STE 100
ALPINE UT
84004-1889
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-3570
  • Fax:
Mailing address:
  • Phone: 801-756-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. GRANT STUCKI
Title or Position: OWNER
Credential: DDS, MS
Phone: 720-775-5843