=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699259465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPINE FAMILY DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2018
-----------------------------------------------------
Last Update Date | 05/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 W MAIN ST STE 10
-----------------------------------------------------
City | BOONTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07005-1156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-793-3844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 SUMMERHILL DR
-----------------------------------------------------
City | MORRIS PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07950-1170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | SHARMILA CHOPRA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 817-793-3844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------