Healthcare Provider Details

I. General information

NPI: 1770440141
Provider Name (Legal Business Name): ALPINE ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 E SPANISH FORK PKWY STE 202
SPANISH FORK UT
84660-1496
US

IV. Provider business mailing address

1642 E SPANISH FORK PKWY STE 202
SPANISH FORK UT
84660-1496
US

V. Phone/Fax

Practice location:
  • Phone: 801-504-6070
  • Fax: 801-504-6068
Mailing address:
  • Phone: 801-504-6070
  • Fax: 801-504-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: RYAN VAN MOORLEHEM
Title or Position: OWNER
Credential: DMD
Phone: 801-504-6070