Healthcare Provider Details

I. General information

NPI: 1871253328
Provider Name (Legal Business Name): ALPEN IMPLANTS AND PERIODONTICS SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2021
Last Update Date: 12/26/2021
Certification Date: 12/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3397 N 1200 E STE 111
LEHI UT
84043-3262
US

IV. Provider business mailing address

4252 S HIGHLAND DR STE 101
SALT LAKE CITY UT
84124-2684
US

V. Phone/Fax

Practice location:
  • Phone: 801-766-6966
  • Fax:
Mailing address:
  • Phone: 801-783-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL THUNELL
Title or Position: MEMBER
Credential: DMD
Phone: 801-783-6249